2015-10-02 11:15:15

  1. 1. Initial Data Load
    1. 1.1. Juana Mariana Gonzales Initial Data Load
      1. 1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old
      2. 1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice
      3. 1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice
      4. 1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent
      5. 1.1.5. Enter Adverse Reaction to the Polio Vaccine
      6. 1.1.6. Enter allergy to egg albumin
    2. 1.2. Juan Marcel Gonzales Initial Data Load
      1. 1.2.1. Enter Initial Demographic Data for New Patient Juan Marcel Gonzales
      2. 1.2.2. Enter Clinical History for Juan Marcel Gonzales
    3. 1.3. Mariela Gonzales Morales Initial Data Load
      1. 1.3.1. Enter Initial Demographic Data for Mariela Gonzales Morales
      2. 1.3.2. Enter Initial Clinical Information for Mariela
    4. 1.4. Juana Maria Gonzales Morales Initial Data Load
      1. 1.4.1. Enter Initial Demographic Data for Juana Maria Gonzales Morales
  2. 2. Query the Registry
    1. 2.1. Query the Registry for Juana Mariana Gonzales
      1. 2.1.1. Select Patient Juana Mariana Gonzales
      2. 2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales
    2. 2.2. Query the Registry for Juan Marcel Gonzales
      1. 2.2.1. Select Patient Juan Marcel Gonzales
      2. 2.2.2. Query Registry for vaccination history and forecast for Juan Marcel Gonzales
    3. 2.3. Query the Registry for Mariela Gonzales Morales
      1. 2.3.1. Select Patient Mariela Gonzales Morales
      2. 2.3.2. Query Registry for vaccination history and forecast for Mariela Gonzales Morales
    4. 2.4. Query the Registry for Juana Maria Gonzales Morales.
      1. 2.4.1. Select Patient Juana Maria Gonzales Morales
      2. 2.4.2. Query Registry for vaccination history and forecast for Juana Maria Gonzales Morales
  3. 3. Display Reconcile Update Immunizations
    1. 3.1. Juana Mariana Gonzales Display Reconcile Update Immunization Information
      1. 3.1.1. View and Compare response to request for vaccination history for Juana Mariana Gonzales
      2. 3.1.2. Mark first MMRV Dose as Invalid
      3. 3.1.3. View the vaccination forecast for Juana Mariana Gonzales
      4. 3.1.4. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales
      5. 3.1.5. View the updated vaccination forecast for Juana Mariana Gonzales
    2. 3.2. Juan Marcel Gonzales Display Reconcile Update Immunization Information
      1. 3.2.1. View and import response to request for vaccination history for Juan Marcel Gonzales
      2. 3.2.2. View the vaccination forecast for Juan Marcel Gonzales returned by the Immunization Registry
      3. 3.2.3. View the vaccination forecast for Juan Marcel Gonzales
    3. 3.3. Mariela Gonzales Morales Display Reconcile Update Immunization Information
      1. 3.3.1. View and import response to request for vaccination history for Mariela Gonzales Morales
      2. 3.3.2. View the vaccination forecast for Mariela Gonzales Morales returned by the Immunization Registry
      3. 3.3.3. View the vaccination forecast for Mariela Gonzales Morales
    4. 3.4. Juana Maria Gonzales Morales Display Reconcile Update Immunization Information
      1. 3.4.1. View and import response to request for vaccination history for Juana Maria Gonzales Morales
      2. 3.4.2. View the vaccination forecast for Juana Maria Gonzales Morales returned by the Immunization Registry
      3. 3.4.3. View the vaccination forecast for Juana Maria Gonzales Morales
  4. 4. Order and Immunize patient
    1. 4.1. Juana Mariana Gonzales, Enter Orders and Immunizations
      1. 4.1.1. Order IPV and view prior reaction
      2. 4.1.2. IPV Parental Refusal
      3. 4.1.3. Order Influenza vaccine and view allergy alert
      4. 4.1.4. Order MMRV Vaccine
      5. 4.1.5. Records Influenza Vaccine administration route with data validation checking
      6. 4.1.6. Record Influenza Vaccine administration
      7. 4.1.7. Records MMRV Vaccine administration route with data validation checking
      8. 4.1.8. Record MMRV Vaccine administration
    2. 4.2. Juan Marcel Gonzales, Enter Orders and Immunizations
      1. 4.2.1. Order intranasal, live virus influenza vaccine and view asthma contraindication
      2. 4.2.2. Orders administration of Hepatitis B vaccine
      3. 4.2.3. Orders administration of DTaP vaccine and alerted that the dose is too early
      4. 4.2.4. Records Hepatitis B Vaccine lot number with expired lot alert
      5. 4.2.5. Record Hepatitis B Vaccine administration
      6. 4.2.6. Records Influenza Vaccine administration with VFC eligibility checking
      7. 4.2.7. Record Influenza Vaccine administration for Juan Marcel Gonzales
    3. 4.3. Mariela Gonzales Morales, Enter Orders and Immunizations
      1. 4.3.1. Enters a deferral for the vaccines due
  5. 5. Transmit Immunization Report
    1. 5.1. Juana Mariana Gonzales Transmit Immunization Report
      1. 5.1.1. Transmit the immunization report to the Immunization Registry
      2. 5.1.2. Record an adverse reaction
      3. 5.1.3. Transmit the updated vaccination report with adverse reaction to the registry
    2. 5.2. Juan Marcel Gonzales Transmit Immunization Report
      1. 5.2.1. Transmit the Immunization Report for Juan Marcel Gonzales
    3. 5.3. Mariela Gonzales Morales Transmit Immunization Report
      1. 5.3.1. Transmit the Immunization Report for Mariela Gonzales Morales
  6. 6. Display Immunization Report
    1. 6.1. Juana Mariana Gonzales Display Immunization Report
      1. 6.1.1. Produce an immunization report for Juana Mariana Gonzales including all history
    2. 6.2. Juan Marcel Gonzales Display Immunization Report
      1. 6.2.1. Produce an immunization report for Juan Marcel Gonzales including all history
    3. 6.3. Mariana Gonzales Morales Display Immunization Report
      1. 6.3.1. Produce an immunization report for Juan Marcel Gonzales including all history
  7. 7. Cohort Report
    1. 7.1. Overdue Immunizations
      1. 7.1.1. Produce Overdue Immunizations Cohort Report

1. Initial Data Load

The initial Data load will consist of the vendor entering data during live interactive testing for 4 patients with various scenarios. The data entry will include demographic data, Immunization histories and specific conditions for each patient.

1.1. Juana Mariana Gonzales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 6-year old Juana Mariana Gonzales. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juana Mariana Gonzales. The data includes immunizations provided by the practice.

The vendor also enters:

? Two vaccines administered at other sites

? ?o an influenza vaccine given at a local pharmacy

? ?o an inactivated polio vaccine given elsewhere and not reported to the registry ? the history includes an adverse reaction (febrile seizure) 8 hours after the vaccine was administered

? Adverse reaction to inactivated polio vaccine (febrile seizure) and the date and source of information

? Allergy to egg albumin administered at this site (the registry has different CVX date and lot number information for this vaccine)

NOTE: the historical vaccines will be imported during the Registry query ?(e.g. from another practice)

Comments
Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

PreCondition
No PreCondition

PostCondition
The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions ?in the record created for Juana Mariana Gonzales?using the test data provided.

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old

Test Step Type: SUT_MANUAL
Juana Mariana Gonzales is entered as a patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Mariana Gonzales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”) Vendor supplied Y
Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name Shoreline Pediatrics Y
Patient ID: Type (e.g., medical record number, IIS ID) Vendor supplied Y
Patient Name: First  Juana Y
Patient Name: Middle Mariana Y
Patient Name: Last Gonzales Y
Patient Date of Birth 12/23/2009 Y
Birth Time 11:05 N
Patient Gender (Administrative Sex) F Y
Patient Multiple Birth Indicator No Y
Patient Birth Order NA C
Responsible Person Name: First Joanna Y
Responsible Person Name: Middle Merida Y
Responsible Person Name: Last Gonzales Y
Responsible Person Name: Relationship to Patient Grandmother Y
Mother’s Name: First Maria Y
Mother’s Name: Middle Merida Y
Mother’s Name: Last Gonzales Y
Mother’s Name: Maiden Last Acosta Y
Patient Address: Street 4345 Standish Way Y
Patient Address: City Stamford Y
Patient Address: State CT Y
Patient Address: Country USA Y
Patient Address: Zipcode 06903 Y
Patient Address: County of Residence Fairfield N
Race White Y
Ethnicity Hispanic or Latino Y
Birthing Facility Name (Birth Delivery Location Address BDL) Shoreline Hospital
325 Shorline Drive, Stamford Connecticut 06901		 [Y - birthing facility name, not address]
Patient Birth State CT Y
Patient Primary Language English Y
Patient Telephone Number (203) 555-1212 Y
Patient Telephone Number Type (e.g., home, cell) home Y
Patient E-mail Address jmg@gmail.com N
Publicity Code   N
Protection Indicator   N
Protection Indicator Effective Date   N
Immunization Registry Status   N
Preferred Contact Method Phone Y

Notes to Testers

No Note

1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice

Test Step Type: SUT_MANUAL
Patient History from the local practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from the local practice for Juana Mariana Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history  the known to the local practice is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]:

Vaccine from Practice HepB    
Entered BY Sandra Molina Y
Ordering Provider Frank Smith Y
Entering Organization Shoreline Pediatrics Y
Administration Notes (Vaccine Event information source) New immunization record (NIP001 00) Y
Date/Time of Start of Administration 1/15/2010 Y
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage  (CVX 08) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Sandra Molina Y
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901 Y
Lot Number 6352FK1 Y
Substance Expiration Date 10/1/2010 Y
Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB) Y
Completion Status CP Y
Route of Administration IM Y
Administration Site Right Thigh Y
     
Vaccine from Practice MMRV    
a. Entered BY J. Martinez Y
b. Ordering Provider Frank Smith Y
c. Entering Organization Shoreline Pediatrics Y
Vaccine Event information source New immunization record (NIP001 00) Y
Value/Text for Vaccine Type  MMRV Y
Date/Time of Start of Administration 10/23/2010 Y
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider
Sandra Molina Y
Administered-at Location
400 Shoreline Drive, Stamford Connecticut 06901
Y
Lot Number 7W27V7491 Y
Substance Expiration Date 12/15/2010 Y
Substance Manufacturer Name Merck Sharp & Dohme Corp (MVX MSD) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM) Y
Administration Site Right Thigh (HL70163 RT)  

Notes to Testers

No Note

1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice

Test Step Type: SUT_MANUAL
Patient History from another practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from another practice into the record for Juana Mariana Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history from another practice is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from another practice as provided, with all required attributes indicated by [Y]:

Historical Vaccine from Another Practice - Dtap    
Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source (Administration Notes) Historical information - from parent’s written record (NIP001 03) Y
Value/Text for Vaccine Type  DTaP Y
Date/Time of Start of Administration 8/31/2014 Y
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D643QS8243 Y
Substance Expiration Date 9/1/2014 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM) Y
Administration Site Left Deltoid (HL70163 LD) Y
     
Historical Vaccine from Another Practice - Polio    
Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from parent’s written record (NIP001 03) Y
Value/Text for Vaccine Type 
poliovirus vaccine, inactivated (CVX 10)
Y
Date/Time of Start of Administration 2/21/2011 Y
Vaccine Administered poliovirus vaccine, inactivated (CVX 10) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D335PV9644 Y
Substance Expiration Date 2/22/2011 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM) Y
Administration Site Left Deltoid (HL70163 LD) Y
Reaction VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS Y

Notes to Testers

No Note

1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent

Test Step Type: SUT_MANUAL
Patient History from a pharmacy as reported by the parent is entered into the EMR.

Test Story

Description

The provider enters immunization data from a pharmacy as reported by the parent for Juana Mariana Gonzales.

 

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic data  in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history from the pharmacy as reported by the parent is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from the pharmacy as provided by the parent with all required attributes indicated by [Y]:

Historical Vaccine from Pharmacy Reported by Parent    
Entered BY Sandra Molina Y
Ordering Provider Gina Ricci Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source (Administration Notes) Historical information - from other provider (NIP001 02) Y
Value/Text for Vaccine Type  Influenza vaccine Y
Date/Time of Start of Administration 10/15/2013 Y
Vaccine Administered influenza, live, intranasal, quadrivalent (CVX 149) FluMist Quadrivalent (NDC 66019-0301-10)) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Gina Ricci Y
Administered-at Location Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901 Y
Lot Number 8L4B3423 Y
Substance Expiration Date 7/1/2014 Y
Substance Manufacturer Name MedImmune, LLC (MVX MED) Y
Completion Status CP Y
Route of Administration Nasal (NCIT NS) Y
Administration Site   Y

Notes to Testers

No Note

1.1.5. Enter Adverse Reaction to the Polio Vaccine

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding adverse events as part of the clinical history.

Test Story

Description

The provider documents in the EMR the clinical history of an adverse reaction to the polio vaccine.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The clinical history of the adverse reaction to the Polio vaccine is documented in the the record created for Juana Mariana Gonzales.

Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided with all required attributes indicated by [Y]:

Adverse Reaction Substance/Agent inactivated polio vaccine (e.g. Poliomyelitis vaccine adverse reaction (disorder) 293117006) Y
Reaction febrile seizure (e.g. Simple febrile seizure (finding) 432354000)
VXC11^convulsions (fits, seizures) within 72 hours of dose^		 Y
Date (of the reaction) 8/31/2014 Y

Notes to Testers

No Note

1.1.6. Enter allergy to egg albumin

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding allergies as part of the clinical history.

Test Story

Description

The provider documents in the EMR the clinical history of an allergy to egg albumin.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The clinical history of the allergy to egg albumin is documented in the record created for Juana Mariana Gonzales

Test Objectives

Supporting data for: Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies. 

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical allergy data provided with all required attributes indicated by [Y]:

Allergy Sugstance/Agent Egg Albumin Allergy (e.g. 213020009 Egg protein allergy (disorder), Allergy to eggs (disorder) 91930004) Y
Date (allergy status known - e.g. thru testing or date of the allergy) 8/31/2014 Y

Notes to Testers

No Note

1.2. Juan Marcel Gonzales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 3 1/2-year old Juan Marcel Gonzales. There are no transactions associated with this test case.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.2.1. Enter Initial Demographic Data for New Patient Juan Marcel Gonzales

Test Step Type: SUT_MANUAL
Juan Marcel Gonzales is entered as a patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juan Marcel Gonzales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juan Marcel Gonzales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”)

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First 

Juan

Y

Patient Name: Middle

Marcel

Y

Patient Name: Last

Gonzales

Y

Patient Date of Birth

NA

Y

Birth Time

NA

N

Patient Gender (Administrative Sex)

NA

Y

Patient Multiple Birth Indicator

11/23/2011 11am

Y

Patient Birth Order

M

C

Responsible Person Name: First

Manuel

Y

Responsible Person Name: Middle

Marcel

Y

Responsible Person Name: Last

Gonzales

Y

Responsible Person Name: Relationship to Patient

Father

Y

Mother’s Name: First

Anita

Y

Mother’s Name: Middle

Francesca

Y

Mother’s Name: Last

Gonzales

Y

Mother’s Name: Maiden Last

Morales

Y

Patient Address: Street

4623 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Shoreline Hospital
325 Shorline Drive, Stamford Connecticut 06901

[Y – birthing

 facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1213

Y

Patient Telephone Number Type (e.g., home, cell)

Home

Y

Patient E-mail Address

None

N

Publicity Code

  

N

Protection Indicator

  

N

Protection Indicator Effective Date

  

N

Immunization Registry Status

  

N

Preferred Contact Method

Phone

  

Notes to Testers

No Note

1.2.2. Enter Clinical History for Juan Marcel Gonzales

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding a problem of Asthma as part of the clinical history.

Test Story

Description

The clinical history of Moderate Persistent Asthma is documented in the record created for Juan Marcel Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juan Marcel Gonzales.

PostCondition

The clinical history of the Moderate Persistent Asthma is documented in the record created for Juan Marcel Gonzales.

Test Objectives

Supporting data for testing contraindications.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical history data provided with all required attributes indicated by [Y]:

Adverse History of Asthma      
Problems Moderate Persistent Asthma (e.g. Moderate persistent asthma – SNOMED-CT 427295004) Y Coded value expected using SNOMED-CT or ICD

Notes to Testers

No Note

1.3. Mariela Gonzales Morales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Mariela Gonzales Morales. There are no transactions associated with this test case.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.3.1. Enter Initial Demographic Data for Mariela Gonzales Morales

Test Step Type: SUT_MANUAL
Mariela Gonzales Morales, infant twin, is entered as a new patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Mariela Gonzales Morales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic  in the record created for Mariela Gonzales Morales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”)

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First 

Mariela

Y

Patient Name: Middle

Gonzales

Y

Patient Name: Last

Morales

Y

Patient Date of Birth

5/30/2015

Y

Birth Time

11am

N

Patient Gender (Administrative Sex)

F

Y

Patient Multiple Birth Indicator

Yes

Y

Patient Birth Order

1

C

Responsible Person Name: First

Joanna

Y

Responsible Person Name: Middle

Elena

Y

Responsible Person Name: Last

Morales

Y

Responsible Person Name: Relationship to Patient

Mother

Y

Mother’s Name: First

Joanna

Y

Mother’s Name: Middle

Elena

Y

Mother’s Name: Last

Morales

Y

Mother’s Name: Maiden Last

Gonzales

Y

Patient Address: Street

3321 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Stamford Regional Hospital
15 Atlantic Avenue, Stamford Connecticut 06903

[Y – birthing

 facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1214

Y

Patient Telephone Number Type (e.g., home, cell)

home

Y

Patient E-mail Address

none

N

Publicity Code

 

N

Protection Indicator

  

N

Protection Indicator Effective Date

  

N

Immunization Registry Status

  

N

Preferred Contact Method

none

  

Notes to Testers

No Note

1.3.2. Enter Initial Clinical Information for Mariela

Test Step Type: SUT_MANUAL
The EHR captures structured data indicating that Mariela has a fever in the current visit.

Test Story

Description

The triage nurse enters basic information on  Mariela Gonzales Morales – she has a fever (Temperature of 100.8o F).

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic  in the record created for Mariela Gonzales Morales.

PostCondition

The clinical record for Mariela Gonzales Morales indicates that she currently has a fever (temperature 100.8oF)..

Test Objectives

Supporting data for documenting contraindications (it could also trigger an alert as a locally configured alert rule): Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s current or historical diagnoses.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical data provided with all required attributes indicated by [Y]:

Vital Signs Fever of 100.1 (@code LOINC 8310-5 @value 100.1)
Vital Signs Observation Date Date of current visit
Problems (If vendor uses problems for alert computations, then this should be included.) Problem list: ( Low grade pyrexia (finding) 304213008) 
Problem Observation Date Date of current visit

Notes to Testers

No Note

1.4. Juana Maria Gonzales Morales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for infant twin Juana Maria Gonzales Morales. There are no transactions associated with this test case.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

1.4.1. Enter Initial Demographic Data for Juana Maria Gonzales Morales

Test Step Type: SUT_MANUAL
Juana Maria Gonzales Morales, infant twin, is entered as a new patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Maria Gonzales Morales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Maria Gonzales Morales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

Patient ID (previously listed as “Medicaid Number”)

Vendor supplied

Y

Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name

Shoreline Pediatrics

Y

Patient ID: Type (e.g., medical record number, IIS ID)

Vendor supplied

Y

Patient Name: First 

Juana

Y

Patient Name: Middle

Maria Gonzales

Y

Patient Name: Last

Morales

Y

Patient Date of Birth

5/30/2015

Y

Birth Time

11:15am

N

Patient Gender (Administrative Sex)

F

Y

Patient Multiple Birth Indicator

Yes

Y

Patient Birth Order

2

C

Responsible Person Name: First

Joanna

Y

Responsible Person Name: Middle

Elena

Y

Responsible Person Name: Last

Morales

Y

Responsible Person Name: Relationship to Patient

Mother

Y

Mother’s Name: First

Joanna

Y

Mother’s Name: Middle

Elena

Y

Mother’s Name: Last

Morales

Y

Mother’s Name: Maiden Last

Gonzales

Y

Patient Address: Street

3321 Standish Way

Y

Patient Address: City

Stamford

Y

Patient Address: State

CT

Y

Patient Address: Country

USA

Y

Patient Address: Zipcode

06903

Y

Patient Address: County of Residence

Fairfield

N

Race

White

Y

Ethnicity

Hispanic or Latino

Y

Birthing Facility Name (Birth Delivery Location Address BDL)

Stamford Regional Hospital
15 Atlantic Avenue, Stamford Connecticut 06903

[Y – birthing

 facility name,

not address]

Patient Birth State

CT

Y

Patient Primary Language

English

Y

Patient Telephone Number

(203) 555-1214

Y

Patient Telephone Number Type (e.g., home, cell)

home

Y

Patient E-mail Address

none

N

Publicity Code

 

N

Protection Indicator

  

N

Protection Indicator Effective Date

  

N

Immunization Registry Status

  

N

Preferred Contact Method

none

  
  • ]

Notes to Testers

No Note

2. Query the Registry

Querying the registry will consist of the vendor creating Z44 messages for each patient to be sent to the registry. The response will be processed as part of the ?Display, Reconcile, Import and Update Immunization Information? activity.

2.1. Query the Registry for Juana Mariana Gonzales

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Gonzales.

Test Story

Description
Query the Registry for Juana Mariana Gonzales

Comments
No Comments

PreCondition
Juana Mariana Gonzales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Gonzales Initial Data Load'

PostCondition
A Z44 Query is generated and submitted to the Immunization Registry/Test tool.

Test Objectives
Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry ?on demand? (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother?s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) ? HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria
The vendor can produce a valid Z44 query in accordance with the test data correctly and without ommission.
The data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers
No Note

2.1.1. Select Patient Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Select patient Juana Mariana Gonzales, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juana Mariana Gonzales is selected as the patient and her record is opened in the EMR. 

Comments

No Comments

PreCondition

Juana Mariana Gonzales Initial Data Load completed.

PostCondition

Juana Mariana Gonzales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Juana Mariana Gonzales from similar sounding names using all of the pediatric demographics:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics 
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied
  • Patient Name: First - Juana 
  • Patient Name: Middle - Mariana 
  • Patient Date of Birth - 12/23/2009 
  • Birth Time - 11:05 
  • Patient Gender (Administrative Sex) - F
  • Patient Multiple Birth Indicator - No 
  • Patient Birth Order -  NA 
  • Responsible Person Name: First - Joanna 
  • Responsible Person Name: Middle - Merida 
  • Responsible Person Name: Last - Gonzales
  • Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent) 
  • Mother’s Name: First - Maria 
  • Mother’s Name: Middle -Merida
  • Mother’s Name: Last - Gonzales
  • Mother’s Name: Maiden Last - Acosta 
  • Patient Address: Street - 4345 Standish Way 
  • Patient Address: City - Stamford
  • Patient Address: State - CT 
  • Patient Address: Country - US 
  • Patient Address: Zipcode - 06903 
  • Patient Address: County of Residence - Fairfield 
  • Race - White
  • Ethnicity - Hispanic or Latino 
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901 
  • Patient Birth State - CT
  • Patient Primary Language - English 
  • Patient Telephone Number - (203) 555-1212 
  • Patient Telephone Number Type (e.g., home, cell) - home 
  • Patient E-mail Address - jmg@gmail.com 
  • Publicity Code  
  • Protection Indicator 
  • Protection Indicator Effective Date 
  • Immunization Registry Status 
  • Preferred Contact Method - Phone  

Notes to Testers

No Note

2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales

Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Juana Mariana Gonzales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariana Gonzales

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.
Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150615001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 200911231105 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Value-Test Case Fixed
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551212 Value-Test Case Fixed
QPD-10 Multiple birth indicator
QPD-11 Birth order

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity
RCP-2.2 Units
RCP-2.2.1 Identifier
RCP-2.2.2 Text
RCP-2.2.3 Name of Coding System
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Date/Time of Birth 11/23/2009 11:05
Sex Female
Patient Address 4345 Standish Way Stamford CT
Patient Phone (203)555-1212

2.2. Query the Registry for Juan Marcel Gonzales

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juan Marcel Gonzales.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

2.2.1. Select Patient Juan Marcel Gonzales

Test Step Type: SUT_MANUAL
Select patient Juan Marcel Gonzales, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juan Marcel Gonzales is selected as the patient and his record is opened in the EMR. 

Comments

No Comments

PreCondition

Juan Marcel Gonzales Initial Data Load completed.

PostCondition

Juan Marcel Gonzales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Juan Marcel Gonzales from similar sounding names using all of the pediatric demographics:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied 
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics 
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied 
  • Patient Name: First - Juan 
  • Patient Name: Middle - Marcel 
  • Patient Name: Last - Gonzales 
  • Patient Date of Birth - 11/23/2011  
  • Birth Time - 11:00 
  • Patient Gender (Administrative Sex) -  M 
  • Patient Multiple Birth Indicator - No 
  • Patient Birth Order -  NA 
  • Responsible Person Name: First - Manuel 
  • Responsible Person Name: Middle - Marcel 
  • Responsible Person Name: Last - Gonzales 
  • Responsible Person Name: Relationship to Patient - Father 
  • Mother’s Name: First - Anita 
  • Mother’s Name: Middle - Francesca 
  • Mother’s Name: Last - Gonzales 
  • Mother’s Name: Maiden Last - Morales 
  • Patient Address: Street - 4623 Standish Way 
  • Patient Address: City - Stamford 
  • Patient Address: State - CT 
  • Patient Address: Country - US 
  • Patient Address: Zipcode - 06903 
  • Patient Address: County of Residence - Fairfield 
  • Race - White
  • Ethnicity - Hispanic or Latino 
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901  
  • Patient Birth State - CT 
  • Patient Primary Language - English 
  • Patient Telephone Number - (203) 555-1213 
  • Patient Telephone Number Type (e.g., home, cell) - home 
  • Patient E-mail Address -  
  • Publicity Code  
  • Protection Indicator 
  • Protection Indicator Effective Date 
  • Immunization Registry Status 
  • Preferred Contact Method - Phone  

Notes to Testers

No Note

2.2.2. Query Registry for vaccination history and forecast for Juan Marcel Gonzales

Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Juan Marcel Gonzales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juan Marcel Gonzales.

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juan Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111231100 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4623 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Value-Test Case Fixed
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551213 Value-Test Case Fixed
QPD-10 Multiple birth indicator
QPD-11 Birth order

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity
RCP-2.2 Units
RCP-2.2.1 Identifier
RCP-2.2.2 Text
RCP-2.2.3 Name of Coding System
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juan Marcel Gonzales
Date/Time of Birth 11/23/2011 11:00
Sex Male
Patient Address 4623 Standish Way Stamford CT
Patient Phone (203)555-1213

2.3. Query the Registry for Mariela Gonzales Morales

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Mariela Gonzales Morales.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

2.3.1. Select Patient Mariela Gonzales Morales

Test Step Type: SUT_MANUAL
Select patient Mariela Gonzales Morales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).

Test Story

Description

Mariela Gonzales Morales is selected as the patient and her record is opened in the EMR. 

Comments

No Comments

PreCondition

Mariela Gonzales Morales Initial Data Load completed.

PostCondition

Mariela Gonzales Morales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria
Tester shall verify that the product can distinguish Mariela Gonzales Morales from similar sounding names and her twin using all of the pediatric demographics:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied 
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics 
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied 
  • Patient Name: First - Mariela 
  • Patient Name: Middle - Gonzales 
  • Patient Name: Last - Morales 
  • Patient Date of Birth - 05/30/2015  
  • Birth Time - 11:00 
  • Patient Gender (Administrative Sex) -  F 
  • Patient Multiple Birth Indicator - Yes 
  • Patient Birth Order -  1 
  • Responsible Person Name: First - Joanna 
  • Responsible Person Name: Middle - Gonzales 
  • Responsible Person Name: Last - Morales 
  • Responsible Person Name: Relationship to Patient - Mother 
  • Mother’s Name: First - Joanna 
  • Mother’s Name: Middle - Gonzales 
  • Mother’s Name: Last - Morales 
  • Mother’s Name: Maiden Last - Gonzales 
  • Patient Address: Street - 3321 Standish Way 
  • Patient Address: City - Stamford 
  • Patient Address: State - CT 
  • Patient Address: Country - US 
  • Patient Address: Zipcode - 06903 
  • Patient Address: County of Residence - Fairfield 
  • Race - White
  • Ethnicity - Hispanic or Latino 
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Stamford Regional Hospital 15 Atlantic Avenue, Stamford Connecticut 06903  
  • Patient Birth State - CT 
  • Patient Primary Language - English 
  • Patient Telephone Number - (203) 555-1214 
  • Patient Telephone Number Type (e.g., home, cell) - home 
  • Patient E-mail Address -  
  • Publicity Code  
  • Protection Indicator 
  • Protection Indicator Effective Date 
  • Immunization Registry Status 
  • Preferred Contact Method - Phone  

Notes to Testers

No Note

2.3.2. Query Registry for vaccination history and forecast for Mariela Gonzales Morales

Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Mariela Gonzales Morales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Mariela Gonzales Morales.

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Morales Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Mariela Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Gonzales Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Gonzales Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201505301115 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Value-Test Case Fixed
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551214 Value-Test Case Fixed
QPD-10 Multiple birth indicator 1 Value-Test Case Fixed
QPD-11 Birth order 1 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity
RCP-2.2 Units
RCP-2.2.1 Identifier
RCP-2.2.2 Text
RCP-2.2.3 Name of Coding System
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Mariela Gonzales Morales
Date/Time of Birth 05/30/2015 11:15
Sex Female
Patient Address 3321 Standish Way Stamford CT
Patient Phone (203)555-1214

2.4. Query the Registry for Juana Maria Gonzales Morales.

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Maria Gonzales Morales

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

2.4.1. Select Patient Juana Maria Gonzales Morales

Test Step Type: SUT_MANUAL
Select patient Juana Maria Gonzales Morales, Infant Twin, distinguishing the patient from other patients with similar demographics (twins).

Test Story

Description

Juana Maria Gonzales Morales is selected as the patient and her record is opened in the EMR. 

Comments

No Comments

PreCondition

Juana Maria Gonzales Morales Initial Data Load completed.

PostCondition

Juana Maria Gonzales Morales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Juana Maria Gonzales Morales from similar sounding names and her twin using all of the pediatric demographics:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied 
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics 
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied 
  • Patient Name: First - Juana 
  • Patient Name: Middle - Maria Gonzales 
  • Patient Name: Last - Morales 
  • Patient Date of Birth - 05/30/2015  
  • Birth Time - 11:15 
  • Patient Gender (Administrative Sex) -  F 
  • Patient Multiple Birth Indicator - Yes 
  • Patient Birth Order -  2 
  • Responsible Person Name: First - Joanna 
  • Responsible Person Name: Middle - Gonzales 
  • Responsible Person Name: Last - Morales 
  • Responsible Person Name: Relationship to Patient - Mother 
  • Mother’s Name: First - Joanna 
  • Mother’s Name: Middle - Gonzales 
  • Mother’s Name: Last - Morales 
  • Mother’s Name: Maiden Last - Gonzales 
  • Patient Address: Street - 3321 Standish Way 
  • Patient Address: City - Stamford 
  • Patient Address: State - CT 
  • Patient Address: Country - US 
  • Patient Address: Zipcode - 06903 
  • Patient Address: County of Residence - Fairfield 
  • Race - White
  • Ethnicity - Hispanic or Latino 
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Stamford Regional Hospital 15 Atlantic Avenue, Stamford Connecticut 06903  
  • Patient Birth State - CT 
  • Patient Primary Language - English 
  • Patient Telephone Number - (203) 555-1214 
  • Patient Telephone Number Type (e.g., home, cell) - home 
  • Patient E-mail Address -  
  • Publicity Code  
  • Protection Indicator 
  • Protection Indicator Effective Date 
  • Immunization Registry Status 
  • Preferred Contact Method - Phone  

Notes to Testers

No Note

2.4.2. Query Registry for vaccination history and forecast for Juana Maria Gonzales Morales

Test Step Type: SUT_INITIATOR
Vendor SHALL be able to Generate a Z44 Query correctly and without ommission according to supplied test data

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Juana Maria Gonzales Morales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Maria Gonzales Morales.

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria

Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.

Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20140515001020-0500
MSH-9 Message Type
MSH-9.1 Message Code QBP
MSH-9.2 Trigger Event Q11
MSH-9.3 Message Structure QBP_Q11
MSH-10 Message Control ID 793543
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number 123456
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID MYEHR
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Morales Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juana Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Gonzales Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Gonzales Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Test Case Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201505301115 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Value-Test Case Fixed
QPD-8.3 City Stamford Value-Test Case Fixed
QPD-8.4 State or Province CT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 06903 Value-Test Case Fixed
QPD-8.6 Country
QPD-8.7 Address Type L Value-Test Case Fixed
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203 Value-Test Case Fixed
QPD-9.7 Local Number 5551214 Value-Test Case Fixed
QPD-10 Multiple birth indicator 1 Value-Test Case Fixed
QPD-11 Birth order 2 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I
RCP-2 Quantity Limited Request
RCP-2.1 Quantity
RCP-2.2 Units
RCP-2.2.1 Identifier
RCP-2.2.2 Text
RCP-2.2.3 Name of Coding System
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Maria Gonzales Morales
Date/Time of Birth 05/30/2015 11:15
Sex Female
Patient Address 3321 Standish Way Stamford CT
Patient Phone (203)555-1214

3. Display Reconcile Update Immunizations

The vendor will receive information back from the registry and show the ability to view and reconcile, and import the information returned by the registry (NOTE: the Z42 message will be provided either manually, or as part of the tool). This test will also look at the system's ability to view the forecast returned by the registry, and create a new forecast after reconciling the information.

3.1. Juana Mariana Gonzales Display Reconcile Update Immunization Information

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

3.1.1. View and Compare response to request for vaccination history for Juana Mariana Gonzales

Test Step Type: TA_RESPONDER
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and compare to those in the EMR.

Test Story

Description

The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EMR in response to the query for patient (Juana Mariana Gonzales). The provider reviews the immunization history from the registry and compares to the immunization history in the EMR. The provider reconciles the information from these sources, importing information known only to the registry, retaining information that is more accurately reflected in the local EMR:

The physician accesses the record for Juana Mariana Gonzales and:
• Reconciles the EHR vaccine history with the history retrieved from the registry:
o Accepts new vaccines from the registry data
o If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)
o Retains the local history for influenza and polio vaccines that are not included in the registry report.

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. 

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them.  The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient’s local immunization history and include the time of the update and the source of the new information.

 
Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

 

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 200912231105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 200911231105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091123
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100115
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101030
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100221
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100121
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101027
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120404
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101023
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 13
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 14
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 15
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 16
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 17
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 18
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 19
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 20
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100323
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 26
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 27
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 28
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 29
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20110221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20110221
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 30
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 31
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 32
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 33
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 34
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 35
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 36
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 37
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 38
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 39
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 40
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 41
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 42
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 43
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 44
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 45
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 46
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 47
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 48
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 49
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 50
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 51
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 52
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 53
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 54
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 55
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 56
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 57
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 58
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 59
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 60
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 61
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 62
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 63
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 64
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 65
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 66
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 67
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 68
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 69
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 70
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 71
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 72
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 73
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 74
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 75
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 76
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 78
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 79
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 80
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 81
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 82
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 83
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 84
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 85
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 86
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 87
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 88
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 89
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 90
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 91
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 92
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 93
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20111123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20111123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 94
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 95
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 96
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 97
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20120523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20120523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 98
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text MMRV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 99
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 101
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20100521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20101023

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20101023
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300013411100521
OBX-5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX-5.3 Name of Coding System
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 102
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text MMRV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 103
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 104
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 105
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20100521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20121122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20121122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300013411100521
OBX-5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX-5.3 Name of Coding System
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20110522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20110523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160131
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 110
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 117
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Juana Mariana Gonzales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Gonzales
Date of Birth 11/23/2009
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/23/2009
Date/Time Administration-End 11/23/2009
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 01/15/2010
Date/Time Administration-End 01/15/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 10/30/2010
Date/Time Administration-End 10/30/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 02/21/2010
Date/Time Administration-End 02/21/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/21/2010
Date/Time Administration-End 01/21/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2010
Date/Time Administration-End 09/25/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/27/2010
Date/Time Administration-End 10/27/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2011
Date/Time Administration-End 10/02/2011
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 04/04/2012
Date/Time Administration-End 04/04/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2011
Date/Time Administration-End 11/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2012
Date/Time Administration-End 05/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 10/23/2010
Date/Time Administration-End 10/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 05/22/2010
Earliest Date to Give 05/22/2010
Latest Date to Give 05/22/2011
Date When Vaccine Overdue 05/23/2011
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2015
Earliest Date to Give 09/01/2015
Latest Date to Give 01/31/2016
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason

3.1.2. Mark first MMRV Dose as Invalid

Test Step Type: SUT_MANUAL
If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is ?invalid? as it was given too early (as notified by the registry).

Test Story

Description

 If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)

Comments

If the EMR already recognizes the dose as invalid, then this step may be skipped. 

PreCondition

MMRV status indicates that the first MMRV dose is valid.

PostCondition

MMRV status for the first MMRV dose administered on 10/23/2010 is set to invalid.

Test Objectives

dose validity is an important aspect of:

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Vendor is able to record that the vaccination dose is invalid with a reason that it was given too early

Notes to Testers

No Note

3.1.3. View the vaccination forecast for Juana Mariana Gonzales

Test Step Type: TA_RESPONDER
Vendor can successfully display the current Immunization Forecast (vaccination names and recommended vaccination dates) as returned by the Registry (Z42).

Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Displays the registry forecast which includes the need for a second, valid MMRV vaccine and also the need for influenza and polio vaccines (since the registry has no information about them)

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. 

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS).  The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. Verify that All forecast vaccines and dates returned by the registry are displayed to the user. 

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Mariana
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Acosta
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 200912231105
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 4345 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551212
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Juana
PID-5.3 Second and Further Given Names or Initials Thereof Mariana
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 200911231105
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091123
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100115
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101030
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100121
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101027
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount .25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121104
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101023
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 13
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 14
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 15
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 16
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 17
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 18
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 19
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 20
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100323

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100323
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 26
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 27
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 28
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 29
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20070517
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20110221

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20110221
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300003511070517
OBX-5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 30
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 31
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 32
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 33
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 34
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 35
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 36
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 37
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 38
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 39
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 40
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 41
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 42
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 43
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 44
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 45
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 46
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 47
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 48
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 49
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 50
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 51
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 52
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 53
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 54
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 55
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 56
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 57
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 58
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 59
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 60
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 61
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 62
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 63
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 64
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 65
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 66
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 67
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 68
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 69
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 70
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 71
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 72
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 73
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 74
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 75
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 76
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 78
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 79
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 80
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 81
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 82
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 83
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 84
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 85
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 86
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 87
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 88
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 89
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 90
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 91
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 92
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 93
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20111123

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20111123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 94
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 95
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 96
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 97
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20111025
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20120523

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20120523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 98
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text MMRV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 99
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 101
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason code
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier 264499004
OBX-5.2 Text Early
OBX-5.3 Name of Coding System SCT
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20100521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20101023

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20101023
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300013411100521
OBX-5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX-5.3 Name of Coding System
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 102
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text MMRV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 103
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 104
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 105
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20100521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20121122

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS presented
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20121122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9
OBX-3.2 Text Document type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300013411100521
OBX-5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX-5.3 Name of Coding System
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F<
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20110522
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20110523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160131
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 110
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20131122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151123
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 117
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Juana Mariana Gonzales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juana Mariana Gonzales
Date of Birth 11/23/2009
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 11/23/2009
Date/Time Administration-End 11/23/2009
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, unspecified formulation
Refusal Reason
Date/Time Administration-Start 01/15/2010
Date/Time Administration-End 01/15/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Refusal Reason
Date/Time Administration-Start 10/30/2010
Date/Time Administration-End 10/30/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address
Other Designation
City
State
Zip Code
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered poliovirus vaccine, inactivated
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 01/21/2010
Date/Time Administration-End 01/21/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 03/23/2010
Date/Time Administration-End 03/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 05/22/2010
Date/Time Administration-End 05/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered pneumococcal conjugate vaccine, 13 valent
Refusal Reason
Date/Time Administration-Start 02/21/2011
Date/Time Administration-End 02/21/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered rotavirus, live, monovalent vaccine
Refusal Reason
Date/Time Administration-Start 01/22/2010
Date/Time Administration-End 01/22/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 09/25/2010
Date/Time Administration-End 09/25/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/27/2010
Date/Time Administration-End 10/27/2010
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 10/02/2011
Date/Time Administration-End 10/02/2011
Administered Amount .25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric
Refusal Reason
Date/Time Administration-Start 11/04/2012
Date/Time Administration-End 11/04/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 11/23/2011
Date/Time Administration-End 11/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Refusal Reason
Date/Time Administration-Start 05/23/2012
Date/Time Administration-End 05/23/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Shoreline Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 10/23/2010
Date/Time Administration-End 10/23/2010
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name Sandra Molina
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 400 Shoreline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose NO
Validity Reason Early
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMRV
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration Subcutaneous
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp
Administration Notes new immunization record
Administering Provider
Name J Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 333 Oceanview Lane
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group IPV
Vaccine Due Date 05/22/2010
Earliest Date to Give 05/22/2010
Latest Date to Give 05/22/2011
Date When Vaccine Overdue 05/23/2011
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 09/01/2015
Earliest Date to Give 09/01/2015
Latest Date to Give 01/31/2016
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 11/22/2013
Earliest Date to Give 11/22/2013
Latest Date to Give 11/22/2015
Date When Vaccine Overdue 11/23/2015
Status in Immunization Series
Forecast Reason

3.1.4. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
The Provider uses the EMR to compare the immunization history results (Z42) returned by the Immunization Registry in response to the Z44 Query with the immunization history in the local system, and reconcile (import/update) records.

Test Story

Description

Juana Maria Gonzales Morales immunization registry provided Evaluated History and Forecast is reconciled with the Immunization history information in the EMR.

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and  the response is available in the EMR for reconciliation and import. 

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria
1. The user imports returned vaccinations as follows:
a. Vaccinations NOT imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 1/15/2010
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
VERIFY that the dose validity is marked as invalid 
b. Vaccinations Imported:
 
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 12/23/2009
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 10/30/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2010,
Including adverse reaction 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2011
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 2/21/2011
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2010
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 2/21/2011
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/25/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/27/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/2/2011
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 11/4/2012
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2011
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2012
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
 

Notes to Testers

No Note

3.1.5. View the updated vaccination forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Using the reconciled vaccine history information, the EMR displays the current Immunization Forecast to the user for Juana Mariana Gonzales.

Test Story

Description

Once the vaccine history is reconciled in the EMR, the vaccine forecast is updated. 

Comments

No Comments

PreCondition

EMR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Gonzales').

PostCondition

An updated vaccine forecast based upon the reconciled vaccine history is available to the user. 

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

1. Verify that the EMR does not include in reconciled vaccine forecast:
IPV due on 5/22/2010
2. Verify that the EMR includes in reconciled vaccine forecast:
IPV due on 11/22/2013
MMR due on 5/22/2011
Varicella due on 5/22/2011
influenza, unspecified formulation due on 10/21/2015
 

Notes to Testers

No Note

3.2. Juan Marcel Gonzales Display Reconcile Update Immunization Information

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

3.2.1. View and import response to request for vaccination history for Juan Marcel Gonzales

Test Step Type: TA_RESPONDER
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR

Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and:

• Accepts the vaccines provided by the registry as this is a new patient and there are no prior vaccines recorded

• Views the registry history including the second dose of Hepatitis B vaccine given late (at 2 years of age) and no history of a third dose; influenza vaccine was also not given since 2013

Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.

PreCondition

 

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and  the response is available in the EMR for reconciliation and import.

 

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juan Marcel Gonzales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

2. The user imports returned vaccinations as follows:

a. Vaccinations Imported:

hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 11/23/2011
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 12/23/2013
Verify that the EMR is alerted that this dose was given too late
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/22/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/21/2012
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/20/2013
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/22/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/21/2012
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 11/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 3/22/2012
poliovirus vaccine, inactivated (CVX 10) administered 5/21/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/22/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/21/2012
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 11/22/2012
rotavirus, live, monovalent vaccine (CVX 119) administered 1/22/2012
rotavirus, live, monovalent vaccine (CVX 119) administered 3/22/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/22/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/20/2012
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/30/2013
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/21/2013
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 12/1/2013
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
 

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juan
QPD-4.3 Second and Further Given Names or Initials Thereof Marcel
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code L
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111231100
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551213
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Juan
PID-5.3 Second and Further Given Names or Initials Thereof Marcel
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201111231100
PID-8 Administrative Sex M
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111123
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111223
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130220
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120512
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120222
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120922
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121022
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131030
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130521
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text Hepatitis A
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131201
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text Hepatitis A
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130112
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text MMR and Varicella
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Thigh Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 13
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 14
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 15
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 16
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 17
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 18
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 19
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 20
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 30
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 31
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 32
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 33
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 34
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 35
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 36
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 37
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 38
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 39
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 40
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 41
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 42
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 17
OBX-5.2 Text Hib, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 43
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 44
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 10
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 45
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 10
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 46
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 47
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 48
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 11
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 49
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 11
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 50
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text poliovirus vaccine, inactivated
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 51
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 52
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 12
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 53
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 12
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 54
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 55
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 56
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 57
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 58
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 59
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 60
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 61
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 62
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 63
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 64
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 65
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 66
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 67
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 68
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 16
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 69
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 16
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 66
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 109
OBX-5.2 Text pneumococcal, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 71
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 72
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 73
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 74
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 75
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 76
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 18
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 18
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 74
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 75
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 76
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 19
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 19
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 78
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 79
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 80
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 81
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 82
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 83
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 84
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 85
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 86
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 87
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 90
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 91
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 92
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 93
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 94
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 95
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 96
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 22
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 97
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 22
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 98
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 94
OBX-5.2 Text MMRV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 99
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 96
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 97
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 24
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 25
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 26
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151022
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 110
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 27
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 116
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Juan Marcel Gonzales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juan Marcel Gonzales
Date of Birth 11/23/2011
Sex Male
Address 1
Street 4623 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Anita Francesca Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Shoreline Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 11/23/2011
Date/Time Administration-End 11/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 325 Shorline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 12/23/2011
Date/Time Administration-End 12/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 05/21/2012
Date/Time Administration-End 05/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 02/20/2013
Date/Time Administration-End 02/20/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 05/12/2012
Date/Time Administration-End 05/12/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 02/22/2012
Date/Time Administration-End 02/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 05/21/2012
Date/Time Administration-End 05/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 05/21/2012
Date/Time Administration-End 05/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered Rotavirus
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered Rotavirus
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration IM
Administration Site Thigh Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza
Refusal Reason
Date/Time Administration-Start 09/22/2012
Date/Time Administration-End 09/22/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza
Refusal Reason
Date/Time Administration-Start 10/22/2012
Date/Time Administration-End 10/22/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza
Refusal Reason
Date/Time Administration-Start 10/30/2013
Date/Time Administration-End 10/30/2013
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered Hepatitis A
Refusal Reason
Date/Time Administration-Start 05/21/2013
Date/Time Administration-End 05/21/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered Hepatitis A
Refusal Reason
Date/Time Administration-Start 12/01/2013
Date/Time Administration-End 12/01/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMRV
Vaccine Administered MMR and Varicella
Refusal Reason
Date/Time Administration-Start 01/12/2013
Date/Time Administration-End 01/12/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 05/21/2012
Earliest Date to Give 05/21/2012
Latest Date to Give 05/21/2013
Date When Vaccine Overdue 05/23/2013
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 10/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue
Status in Immunization Series
Forecast Reason

3.2.2. View the vaccination forecast for Juan Marcel Gonzales returned by the Immunization Registry

Test Step Type: TA_RESPONDER
The EMR displays the current Immunization Forecast to the user for Juan Marcel Gonzales as returned by the Immunization Registry Z42 response.

Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and:

• Views the vaccine forecast provided by the Immunization Registry      

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing

PostCondition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS).  The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juan
QPD-4.3 Second and Further Given Names or Initials Thereof Marcel
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code L
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201111231100
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551213
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Juan
PID-5.3 Second and Further Given Names or Initials Thereof Marcel
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201111231100
PID-8 Administrative Sex M
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111123
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111223
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130220
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120512
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120222
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 1.0
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120922
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121022
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131030
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130521
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text Hepatitis A
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131201
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text Hepatitis A
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130112
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text MMR and Varicella
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Thigh Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 13
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 14
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 15
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 16
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 17
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 18
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 19
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 20
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 30
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 31
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 32
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 33
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 34
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 35
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 36
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 37
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 38
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 39
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 40
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 41
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 42
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 43
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 44
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 10
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 45
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 10
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 46
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 47
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 48
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 11
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 49
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 11
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 50
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 51
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 52
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 12
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 53
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 12
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 54
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 55
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 56
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 57
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 58
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 59
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 60
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 61
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 14
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 62
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 63
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 64
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 65
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 15
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 66
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 67
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 68
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 16
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 69
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 16
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 66
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 71
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 72
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 73
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 74
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 75
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 76
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 18
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 18
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 74
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 75
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 76
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 19
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 77
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 19
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 78
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 79
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 80
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 81
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 82
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 83
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 84
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 85
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 20
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 86
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 87
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 90
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 91
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 92
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 93
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 94
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 95
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 96
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 22
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 97
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 22
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 98
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 99
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 96
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 97
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20120521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20130523
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 24
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 25
OBX-5 Observation Value 5
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 26
OBX-5 Observation Value 4
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151022
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 110
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 27
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 116
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20151122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171121
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20171122
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 117
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Juan Marcel Gonzales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Juan Marcel Gonzales
Date of Birth 11/23/2011
Sex Male
Address 1
Street 4623 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Anita Francesca Morales
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Shoreline Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 11/23/2011
Date/Time Administration-End 11/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 325 Shorline Drive
Other Designation
City Stamford
State CT
Zip Code 06901
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 12/23/2011
Date/Time Administration-End 12/23/2011
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 05/21/2012
Date/Time Administration-End 05/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Vaccine Administered DTaP
Refusal Reason
Date/Time Administration-Start 02/20/2013
Date/Time Administration-End 02/20/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 5
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 05/12/2012
Date/Time Administration-End 05/12/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hib, unspecified formulation
Vaccine Administered Hib
Refusal Reason
Date/Time Administration-Start 02/22/2012
Date/Time Administration-End 02/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group poliovirus vaccine, inactivated
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Polio (IPV)
Refusal Reason
Date/Time Administration-Start 05/21/2012
Date/Time Administration-End 05/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Deltoid
Substance Manufacturer Name MSanofi Pasteur Inc.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 01/22/2012
Date/Time Administration-End 01/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 05/21/2012
Date/Time Administration-End 05/21/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 3
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group pneumococcal, unspecified formulation
Vaccine Administered Pneumococcal conjugate (PCV13)
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Pfizer, Inc
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 4
Number of Doses in Series 4
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered Rotavirus
Refusal Reason
Date/Time Administration-Start 11/22/2012
Date/Time Administration-End 11/22/2012
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group rotavirus, unspecified formulation
Vaccine Administered Rotavirus
Refusal Reason
Date/Time Administration-Start 03/22/2012
Date/Time Administration-End 03/22/2012
Administered Amount 1.0
Administered Units of Measure mL
Route of Administration IM
Administration Site Thigh Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza
Refusal Reason
Date/Time Administration-Start 09/22/2012
Date/Time Administration-End 09/22/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza
Refusal Reason
Date/Time Administration-Start 10/22/2012
Date/Time Administration-End 10/22/2012
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Thigh
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group influenza, unspecified formulation
Vaccine Administered Influenza
Refusal Reason
Date/Time Administration-Start 10/30/2013
Date/Time Administration-End 10/30/2013
Administered Amount 0.25
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name Sanofi Pasteur
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series
Number of Doses in Series
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered Hepatitis A
Refusal Reason
Date/Time Administration-Start 05/21/2013
Date/Time Administration-End 05/21/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Right Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group Hep A, unspecified formulation
Vaccine Administered Hepatitis A
Refusal Reason
Date/Time Administration-Start 12/01/2013
Date/Time Administration-End 12/01/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Deltoid
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose
Validity Reason
Completion Status* Complete
Dose Number in Series 2
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
Entering Organization Oceanview Pediatrics
Vaccine Group MMRV
Vaccine Administered MMR and Varicella
Refusal Reason
Date/Time Administration-Start 01/12/2013
Date/Time Administration-End 01/12/2013
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration SC
Administration Site Left Thigh
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Administration Notes
Administering Provider
Name J. Martinez
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 4253 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 2
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 05/21/2012
Earliest Date to Give 05/21/2012
Latest Date to Give 05/21/2013
Date When Vaccine Overdue 05/23/2013
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 10/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 11/22/2015
Earliest Date to Give 11/22/2015
Latest Date to Give 11/21/2017
Date When Vaccine Overdue 11/22/2017
Status in Immunization Series
Forecast Reason

3.2.3. View the vaccination forecast for Juan Marcel Gonzales

Test Step Type: SUT_MANUAL
The EMR displays the current Immunization Forecast to the user for Juan Marcel Gonzales either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and, once the vaccine history is reconciled in the EMR, the vaccine forecast is updated :

• The provider views the updated vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)

Comments

The vaccine forecast may be imported from the Immunization Registry Vaccination History and Forecast (Z42) response, or it may be generated by EMR defined means.

PreCondition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juan Marcel Gonzales)

PostCondition

A vaccine forecast based upon the imported vaccine history is available to the user. 

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 5/21/2012
DTaP due on 11/22/2015
IPV due on 11/22/2015
MMR due on 11/22/2015
Varicella due on 11/22/2015
influenza, unspecified formulation due on Oct 22, 2015 or later

Notes to Testers

No Note

3.3. Mariela Gonzales Morales Display Reconcile Update Immunization Information

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

3.3.1. View and import response to request for vaccination history for Mariela Gonzales Morales

Test Step Type: TA_RESPONDER
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR.

Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:

• Accepts the single vaccine in the registry record into the EHR history

Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and  the response is available in the EMR for reconciliation and import.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Mariela Gonzales Morales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

2. The user imports returned vaccinations as follows:

 

a. Vaccinations Imported:

                hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 3/30/2015

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Mariela
QPD-4.3 Second and Further Given Names or Initials Thereof
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201505301100
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Mariela
PID-5.3 Second and Further Given Names or Initials Thereof Gonzales
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201505301100
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150530
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150730
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 201501126
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 201501126
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170530
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 110
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160827
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160828
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 116
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160827
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160828
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 117
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Mariela Gonzales Morales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Mariela Gonzales Morales
Date of Birth 05/30/2015
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 05/30/2015
Date/Time Administration-End 03/30/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 06/29/2015
Earliest Date to Give 06/29/2015
Latest Date to Give 07/29/2015
Date When Vaccine Overdue 07/30/2015
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 01/12/2015
Earliest Date to Give 01/12/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason

3.3.2. View the vaccination forecast for Mariela Gonzales Morales returned by the Immunization Registry

Test Step Type: TA_RESPONDER
The EMR displays the current Immunization Forecast to the user for Mariela Gonzales Morales as returned by the Immunization Registry Z42 response.

Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:

• Views the vaccine forecast provided by the Immunization Registry


Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing

PostCondition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS).  The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Gonzales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Mariela
QPD-4.3 Second and Further Given Names or Initials Thereof
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Morales
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 201505301100
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Mariela
PID-5.3 Second and Further Given Names or Initials Thereof Gonzales
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 201505301100
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150530
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 31
OBX-5.2 Text Hep B Peds NOS
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 45
OBX-5.2 Text Hep B, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150730
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 107
OBX-5.2 Text DTaP, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 08
OBX-5.2 Text Hib
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 10
OBX-5.2 Text IPV
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 152
OBX-5.2 Text Pneumococcal Conjugate, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 122
OBX-5.2 Text rotavirus, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 88
OBX-5.2 Text influenza, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 201501126
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 201501126
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 85
OBX-5.2 Text Hep A, unspecified formulation
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170530
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 110
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-5.1 Identifier 03
OBX-5.2 Text MMR
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160827
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160828
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier 21
OBX-5.2 Text Varicella
OBX-5.3 Name of Coding System CVX
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC16
OBX-5.2 Text ACIP
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 116
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160827
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160828
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 117
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Mariela Gonzales Morales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name Mariela Gonzales Morales
Date of Birth 05/30/2015
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 05/30/2015
Date/Time Administration-End 03/30/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 06/29/2015
Earliest Date to Give 06/29/2015
Latest Date to Give 07/29/2015
Date When Vaccine Overdue 07/30/2015
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 01/12/2015
Earliest Date to Give 01/12/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason

3.3.3. View the vaccination forecast for Mariela Gonzales Morales

Test Step Type: SUT_MANUAL
The EMR displays the current Immunization Forecast to the user for Mariela Gonzales Morales either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:

• Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)

Comments

No Comments

PreCondition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Mariela Gonzales Morales)

PostCondition

A vaccine forecast based upon the imported vaccine history is available to the user. 

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 6/29/2015
DTaP due on 7/29/2015
Hib due on 7/29/2015
IPV due on 7/29/2015
Pneumococcal conjugate due on 7/29/2015
Rotavirus due on 7/29/2015
  HepA due on 5/29/2016
  MMR due on 5/29/2016
Varicella due on 5/29/2016

influenza, unspecified formulation due on Nov 26, 2015 or later


Notes to Testers

No Note

3.4. Juana Maria Gonzales Morales Display Reconcile Update Immunization Information

Using the Z42 Response to Immunization Registry Query, the EMR displays the Evaluated History and Forecast to the user for reconciliation and update.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

3.4.1. View and import response to request for vaccination history for Juana Maria Gonzales Morales

Test Step Type: TA_RESPONDER
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and import them into the EMR.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

• Accepts the single vaccine in the registry record into the EHR history

Comments

There is no reconciliation step as there are no historical immunizations in the EMR. All will be imported from the Z42 response.

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and  the response is available in the EMR for reconciliation and import.

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Maria Gonzales Morales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

2. The user imports returned vaccinations as follows:

 

a. Vaccinations Imported:

                hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 3/30/2015

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z42
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Morales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Gonzales
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Gonzales
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code F
QPD-6 PatientDateOfBirth
QPD-6.1 Time 053020151100
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name BG2
PID-5.3 Second and Further Given Names or Initials Thereof
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 053020151115
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150530
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150730
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
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OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-6 Units
OBX-6.1 Identifier
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OBX-6.3 Name of Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX : Observation/Result
Location Data Element Data Categorization
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OBX : Observation/Result
Location Data Element Data Categorization
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-6.3 Name of Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX : Observation/Result
Location Data Element Data Categorization
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-6.3 Name of Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-6.3 Name of Coding System
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OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
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OBX-3.1 Identifier 59779-9
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OBX-3.3 Name of Coding System LN
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OBX-3.6 Name of Alternate Coding System
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OBX-6.3 Name of Coding System
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OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-2 Value Type DT
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OBX-6.3 Name of Coding System
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OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
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OBX-6.3 Name of Coding System
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OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-2 Value Type NM
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OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
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OBX-6 Units
OBX-6.1 Identifier
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OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
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OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
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OBX-3.3 Name of Coding System LN
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OBX-3.6 Name of Alternate Coding System
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OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
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OBX-6 Units
OBX-6.1 Identifier
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OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
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OBX-3 Observation Identifier
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OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
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OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-6.3 Name of Coding System
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OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-3.6 Name of Alternate Coding System
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OBX-6.1 Identifier
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OBX-6.3 Name of Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-3.6 Name of Alternate Coding System
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OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
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OBX-2 Value Type CE
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OBX-6 Units
OBX-6.1 Identifier
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OBX-6.3 Name of Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
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OBX-3.3 Name of Coding System LN
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OBX-3.6 Name of Alternate Coding System
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OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
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OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
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OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
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OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
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OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
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OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
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OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
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OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
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OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
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OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
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OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 116
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160827
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160828
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 117
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Juana Maria Gonzales Morales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name BG2 Gonzales
Date of Birth 20/15/0530
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 05/30/2015
Date/Time Administration-End 03/30/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 06/29/2015
Earliest Date to Give 06/29/2015
Latest Date to Give 07/29/2015
Date When Vaccine Overdue 07/30/2015
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 01/12/2015
Earliest Date to Give 01/12/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason

3.4.2. View the vaccination forecast for Juana Maria Gonzales Morales returned by the Immunization Registry

Test Step Type: TA_RESPONDER
The EMR displays the current Immunization Forecast to the user for Juana Maria Gonzales Morales as returned by the Immunization Registry Z42 response.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

• Views the vaccine forecast provided by the Immunization Registry


Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry, a Z42 response is provided back to the EMR, and the vaccine forecast from the response is available in the EMR for viewing

PostCondition

The vaccine forecast from the Immunization Registry is available for viewing in the EMR.

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS).  The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID MYIIS
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID MyStateIIS
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID MYEHR
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID Myclinic
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20091130020020-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID 7731029
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name A_Clinic
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID X68
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code AN
MSH-22.10 Organization Identifier A_Clinic1234
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID 793543

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag 37374859
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text Request Evaluated History and Forecast
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z42
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 37374859
QPD-3 PatientList
QPD-3.1 ID Number
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Morales
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Juana
QPD-4.3 Second and Further Given Names or Initials Thereof Maria Gonzales
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Gonzales
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code F
QPD-6 PatientDateOfBirth
QPD-6.1 Time 053020151100
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 3321 Standish Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Stamford
QPD-8.4 State or Province CT
QPD-8.5 Zip or Postal Code 06903
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 203
QPD-9.7 Local Number 5551214
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name BG2
PID-5.3 Second and Further Given Names or Initials Thereof
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 053020151115
PID-8 Administrative Sex F
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4345 Standish Way
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford
PID-11.4 State or Province CT
PID-11.5 Zip or Postal Code 06903
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text Stamford Regional Hospital
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier STIIS
ORC-17.2 Text StateIIS
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150530
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Pike
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Susan
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150601
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 59782-3
OBX-3.2 Text number of doses in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 3
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 100
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text Dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150629
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
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OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
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OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
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OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 2
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
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OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 9
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 13
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 17
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20150729
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 21
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 201501126
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 201501126
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 23
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 106
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 107
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20170530
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 109
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 28
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 110
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 111
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 112
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160827
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160828
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 113
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 30
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 114
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 115
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 116
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160529
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59777-3
OBX-3.2 Text Latest date next dose may be given
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160827
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 108
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 59778-1
OBX-3.2 Text Date dose is overdue
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20160828
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 117
OBX-2 Value Type NM
OBX-3 Observation Identifier
OBX-3.1 Identifier 30973-2
OBX-3.2 Text dose number in series
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 31
OBX-5 Observation Value 1
OBX-6 Units
OBX-6.1 Identifier NA
OBX-6.2 Text
OBX-6.3 Name of Coding System HL70353
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20141216

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID Juana Maria Gonzales Morales Display Reconcile Update Immunization Information
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier
ID Number 123456
Assigning Authority
Namespace ID MYEHR
ID Type MR
Patient Identifier
ID Number 987633
Assigning Authority
Namespace ID MYIIS
ID Type SR
Name BG2 Gonzales
Date of Birth 20/15/0530
Sex Female
Address 1
Street 4345 Standish Way
Other Designation
City Stamford
State CT
Zip Code 06903
Country USA
Address Type L
Mother's Maiden Name Maria Merida Acosta
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History Information
Entering Organization Stamford Regional Hospital
Vaccine Group Hep B Peds NOS
Vaccine Administered Hepatitis B
Refusal Reason
Date/Time Administration-Start 05/30/2015
Date/Time Administration-End 03/30/2015
Administered Amount 0.5
Administered Units of Measure mL
Route of Administration IM
Administration Site Left Thigh
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Administration Notes
Administering Provider
Name Susan Pike
ID Number
Administered-at Location
Facility ID DCS_DC
Street Address 15 Atlantic Avenue
Other Designation
City Stamford
State CT
Zip Code 06903
Country
Valid Dose YES
Validity Reason
Completion Status* Complete
Dose Number in Series 1
Number of Doses in Series 3
Immunization Series Name
Status in Immunization Series
Immunization Schedule Used ACIP
 
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Hep B, unspecified formulation
Vaccine Due Date 06/29/2015
Earliest Date to Give 06/29/2015
Latest Date to Give 07/29/2015
Date When Vaccine Overdue 07/30/2015
Status in Immunization Series
Forecast Reason
Vaccine Group DTaP, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hib
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group IPV
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Pneumococcal Conjugate, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group rotavirus, unspecified formulation
Vaccine Due Date 07/29/2015
Earliest Date to Give 07/29/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group influenza, unspecified formulation
Vaccine Due Date 01/12/2015
Earliest Date to Give 01/12/2015
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group Hep A, unspecified formulation
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 05/29/2017
Date When Vaccine Overdue 05/30/2017
Status in Immunization Series
Forecast Reason
Vaccine Group MMR
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason
Vaccine Group Varicella
Vaccine Due Date 05/29/2016
Earliest Date to Give 05/29/2016
Latest Date to Give 08/27/2016
Date When Vaccine Overdue 08/28/2016
Status in Immunization Series
Forecast Reason

3.4.3. View the vaccination forecast for Juana Maria Gonzales Morales

Test Step Type: SUT_MANUAL
The EMR displays the current Immunization Forecast to the user for Juana Maria Gonzales Morales either as returned by the IIS in prior step, or as generated thru any local means.

Test Story

Description

The physician accesses the record for Juana Maria Gonzales Morales and:

• Views the vaccine forecast (either as provided by the Immunization Registry or as determined through EMR defined methods)

Comments

No Comments

PreCondition

EMR Vaccine History is imported from the Immunization History returned from the Immunization Registry (previous step 'View and import response to request for vaccination history for Juana Maria Gonzales Morales)

PostCondition

A vaccine forecast based upon the imported vaccine history is available to the user.


Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

1. Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:
2. Verify that the EMR includes in the vaccine forecast:

Hep B Peds NOS due on 6/29/2015
DTaP due on 7/29/2015
Hib due on 7/29/2015
IPV due on 7/29/2015
Pneumococcal conjugate due on 7/29/2015
Rotavirus due on 7/29/2015
  HepA due on 5/29/2016
  MMR due on 5/29/2016
Varicella due on 5/29/2016
influenza, unspecified formulation due on Nov 26, 2015 or later

Notes to Testers

No Note

4. Order and Immunize patient

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. NOTE: There are no orders or immunizations in this test plan for Juana Maria Gonzales.

4.1. Juana Mariana Gonzales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

4.1.1. Order IPV and view prior reaction

Test Step Type: SUT_MANUAL
The provider selects to order IPV and views information about the prior febrile seizure post-IPV vaccine.

Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures).

Test Objectives

Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type  IPV (CVX 10)
Date/Time Vaccine Refusal was recorded Current Date
Alert  Alerts user to information about the prior febrile seizure post-IPV vaccine

Notes to Testers

No Note

4.1.2. IPV Parental Refusal

Test Step Type: SUT_MANUAL
Documents mother?s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.

Test Story

Description

The mother is concerned about administering the IPV due to the prior adverse reaction, and refuses to have the child immunized for IPV. The provider documents mother’s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.

Comments

No Comments

PreCondition

Prior Immunization History loaded and reconciled from the Immunization Registry. Order is attempted for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures.

PostCondition

Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is permanent.

Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.).  The system also stores that information in a structured way so it can be reported and analyzed as needed.

Evaluation Criteria

EMR documents the non-administration of the IPV due to the parental refulsal:

Substance/Treatment Refusal Reason Parental decision (NIP002 00)
Completion Status RE
Date/Time Vaccine Deferral was recorded Current Date
Deferral Reason Parental decision (NIP002 00)
Deferral Status Permanent

Notes to Testers

No Note

4.1.3. Order Influenza vaccine and view allergy alert

Test Step Type: SUT_MANUAL
The provider orders inactivated influenza vaccine and is notified that the patient as allergy to egg albumin.

Test Story

Description

The provider orders inactivated influenza vaccine and is notified that the patient as allergy to egg albumin

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

Intranasal form of the Influenza vaccine is ordered for the patient.


Test Objectives

Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Order Value/Text for Vaccine Type  Influenza, injectable,quadrivalent, preservative free, pediatric (CVX161)
Date/Time Vaccine  was recorded Current Date
Alert Alerts user to information that patient has Egg Allergy

 

Provider changes the order to modifies the Vaccine type:

Vaccine Type:  Influenza virus vaccine, live, attenuated, for intranasal use (CVX 111)

Notes to Testers

No Note

4.1.4. Order MMRV Vaccine

Test Step Type: SUT_MANUAL
The provider orders an MMRV vaccine as a catch-up dose.

Test Story

Description

As indicated by the vaccine forecast, the first MMRV administered was invalid as it was administered too soon. The provider orders MMRV as a catch-up dose.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

MMRV vaccine is ordered for the patient.

Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Order Value/Text for Vaccine Type  measles, mumps, rubella, and varicella virus vaccine (CVX 94 )
Date/Time Vaccine  was recorded Current Date

Notes to Testers

No Note

4.1.5. Records Influenza Vaccine administration route with data validation checking

Test Step Type: SUT_MANUAL
The provider records the vaccine administration in the EMR and is prevented from incorrectly documenting vaccine route.

Test Story

Description

The nurse documents administration route for the nasal live, attenuated influenza vaccine
• Is prevented from documenting “IM” for live, attenuated influenza vaccine
 

Comments

This step covers data quality checking as an informative aspect of vaccine administration

PreCondition

Order is placed for nasal live, attenuated influenza vaccine.

PostCondition

The nasal live, attenuated influenza vaccination route has failed to be recorded as intramuscular in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Sample of data quality checking for vaccine route.

Evaluation Criteria

The EMR prevents the user for entering 'Intramuscular' as a route for the the nasal live, attenuated influenza vaccine.

Notes to Testers

No Note

4.1.6. Record Influenza Vaccine administration

Test Step Type: SUT_MANUAL
The provider documents in the EMR all attributes associated with the new vaccine administration.

Test Story

Description

 

 

The nurse administers the the nasal live, attenuated influenza vaccine
• Documents all required information for each vaccine

 

 

Comments

No Comments

PreCondition

Order is placed for nasal live, attenuated influenza vaccine.

PostCondition

The nasal live, attenuated influenza vaccinations is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source (Administration Notes) New immunization record (NIP001 00)
Value/Text for Vaccine Type  influenza virus vaccine, live, attenuated, for intranasal use (CVX 111), FluMist Quadrivalent (NDC 66019-0301-10)
Date/Time of Start of Administration Current Date
Vaccine Administered influenza virus vaccine, live, attenuated, for intranasal use (CVX 111), FluMist Quadrivalent (NDC 66019-0301-10)
Administered Amount (of Vaccine) 0.2
Administered Units (of Measure) mL
Administering Provider Sandra Molina
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901
Lot Number 8L4B3521
Substance Expiration Date 8/15/2015
Substance Manufacturer Name MedImmune,LLC (MVX MED)
Completion Status CP
Route of Administration Nasal (NCIT C38284), Nasal (HL70162 NS)
Administration Site  
VFC Eligibility No

                  

 

Notes to Testers

No Note

4.1.7. Records MMRV Vaccine administration route with data validation checking

Test Step Type: SUT_MANUAL
The provider records the vaccine administration route in the EMR and is prevented from incorrectly documenting vaccine route

Test Story

Description

The nurse documents administration route for the MMRV vaccine
• Is prevented from documenting “oral” for MMRV vaccine
 

Comments

This step covers data quality checking as an informative aspect of vaccine administration

PreCondition

Order is placed for MMRV vaccine.

PostCondition

The MMRV vaccination route has failed to be recorded as 'oral' in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Sample of data quality checking for vaccine route.

Evaluation Criteria

The EMR prevents the user for entering 'Oral' as a route for the the MMRV vaccine.

Notes to Testers

No Note

4.1.8. Record MMRV Vaccine administration

Test Step Type: SUT_MANUAL
The provider documents in the EMR all attributes associated with the new vaccine administration.

Test Story

Description

 

 

The nurse administers the the MMRV vaccine
• Documents all required information for each vaccine

 

 

Comments

No Comments

PreCondition

Order is placed for MMRV vaccine.

PostCondition

The MMRV vaccination is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Order Value/Text for Vaccine Type  measles, mumps, rubella, and varicella virus vaccine (CVX 94 ), ProQuad (NDC 00006-4999-00)
Date/Time Vaccine  was recorded Current Date
Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Date/Time of Start of Administration Current Date
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine (CVX 94 ),
ProQuad (NDC 00006-4999-00)
Administered Amount (of Vaccine) 0.5
Administered Units (of Measure) mL
Administration Notes  
Administering Provider Sandra Molina
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901
Lot Number 7W87V3687
Substance Expiration Date 7/15/2015
Substance Manufacturer Name Merck Sharp & Dohme Corp (MVX MSD)
Completion Status CP
Route of Administration Subcutaneous (NCIT C38299, HL70162: SC)
Administration Site Left Deltoid (HL70162 LD)
VFC Eligibility No

Notes to Testers

No Note

4.2. Juan Marcel Gonzales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

4.2.1. Order intranasal, live virus influenza vaccine and view asthma contraindication

Test Step Type: SUT_MANUAL
Selects selects to order intranasal, live virus influenza vaccine and views information about patient asthma problem which is a contraindication to the intranasal vaccine.

Test Story

Description

The physician accesses the record for Juan Marcel Gonzales and:

• Orders administration of Influenza vaccine (intranasal, live virus vaccine)

• Receives notification the patient has asthma, a relative contraindication for intranasal influenza vaccine

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

User notified of history of contraindication tto nfluenza virus vaccine, live, attenuated, for intranasal use (CVX 111)
of asthma on problem list. Order is changed to Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
.

Test Objectives

Modify Antigen Recommendations Based on Active Diagnoses: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s current or historical diagnoses.

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type  influenza virus vaccine, live, attenuated, for intranasal use (CVX 111)
Date/Time Vaccine Refusal was recorded Current Date
Alert Notification the patient has asthma, a relative contraindication for intranasal influenza vaccine.

The Provider changes the order to:

Vaccine Type:   Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)

Notes to Testers

No Note

4.2.2. Orders administration of Hepatitis B vaccine

Test Step Type: SUT_MANUAL
The provider orders a Hepatitis B vaccine (dose 3).

Test Story

Description

As indicated by the vaccine forecast, the third Hepatitis B is overdue, and is ordered.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast reviewed.

PostCondition

Hepatitis B vaccine is ordered for the patient.

Test Objectives

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Order Value/Text for Vaccine Type  hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
Date/Time Vaccine  was recorded Current Date

Notes to Testers

No Note

4.2.3. Orders administration of DTaP vaccine and alerted that the dose is too early

Test Step Type: SUT_MANUAL
The provider orders a DTaP vaccine (dose 5). The EMR provides an alert that the vaccine dose is too early.

Test Story

Description

  The fifth DTaP is ordered, and the provider is notified that the dose is too early.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. Vaccine forecast is available in the EMR.

PostCondition

DTaP vaccine is ordered for the patient, and provider is notified that the dose is too early.

Test Objectives

Receive Dose Not Indicated Alert for Single Vaccine Order: The EHR or other clinical software system notifies the provider in instances when there are single or combination vaccine orders that are inconsistent with the expected timing intervals included in the vaccine forecast. Inconsistencies include suggestion of different date(s) for ordering the vaccine(s) or indication the vaccine(s) is/are no longer required.

Enter Vaccination Order: The EHR or other clinical software system allows providers to order immunizations for a patient using filters for type of vaccine, including combination vaccines.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type  diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
Date/Time Vaccine order was recorded Current Date
Alert Notification that the dose is too early

Notes to Testers

No Note

4.2.4. Records Hepatitis B Vaccine lot number with expired lot alert

Test Step Type: SUT_MANUAL
The provider records the vaccine administration lot number in the EMR and is alerted of the expired lot.

Test Story

Description

The nurse documents administration lot number for the Hepatitis B vaccine
• Is prevented from ordering the Hepatitis B lot as it has expired
• Documents administration from a different lot that is not expired
 

Comments

PreCondition

Order is placed for Hepatitis B vaccine.

PostCondition

The provider has been notified of the expired Hepatitis B vaccination lot. Documentation of a lot to be administered that is not expired is recorded in the EMR.

Test Objectives

Notify of Vaccine Dose Expiration: The EHR or other clinical software system notifies the provider administering a vaccine if the dose chosen for administration is expired.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Date/Time of Start of Administration Current Date
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)
Lot Number (Expired) 6332FK18
Substance Expiration Date (Expired) 6/15/2015
Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB)
Alert Alerts user to expired lot

Notes to Testers

No Note

4.2.5. Record Hepatitis B Vaccine administration

Test Step Type: SUT_MANUAL
The EMR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

 

 

The nurse administers the the Hepatitis B vaccine
• Documents all required information for the vaccine

 

 

Comments

No Comments

PreCondition

Order is placed for Hepatitis B vaccine.

PostCondition

The Hepatitis B vaccination is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Date/Time of Start of Administration Current Date
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)
Administered Amount (of Vaccine) 0.5
Administered Units (of Measure) mL
Administration Notes  
Administering Provider Sandra Molina
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901
Lot Number 6332FK26
Substance Expiration Date 8/25/2015
Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB)
Completion Status CP
Route of Administration Intramuscular (NCIT C28161, HL70162: IM)
Administration Site Left Deltoid (HL70162 LD)
VFC Eligibility No

Notes to Testers

No Note

4.2.6. Records Influenza Vaccine administration with VFC eligibility checking

Test Step Type: SUT_MANUAL
The provider records the vaccine administration from a VFC source and alerted that the patient is not VFC eligible.

Test Story

Description

The nurse documents administration for the inactivated influenza vaccine from a VFC source
• Is alerted that the patient is not eligible for VFC
• Orders a different non-VFC lot of inactivated influenza vaccine
 

Comments

This step covers data quality checking as an informative aspect of vaccine administration

PreCondition

Order is placed for inactivated influenza vaccine.

PostCondition

The user is notified of vaccine dose ineligibility.

Test Objectives

Notify of Vaccine Dose Ineligibility: The EHR or other clinical software system provides a method for alerting a provider if a vaccine is selected for a patient who is not eligible for the inventory item selected.

Evaluation Criteria

The provider documents a VFC lot to be administered in the EMR. Once notified that the patient is not eligible for the VFC, the a non-VFC lot is selected.

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type  Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)
Date/Time of Start of Administration Current Date
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)
VFC lot (not administered) D8043IN8422
Substance Expiration Date 8/15/2015
Substance Manufacturer Name Sanofi Pasteur (MVX PMC)
Alert Patient is not VFC Eligible

The Provider selects a non-VFC Lot:

Vaccine Lot # (administered):  D8043IN8855
Vaccine Expiration Date: 8/25/2015



Notes to Testers

No Note

4.2.7. Record Influenza Vaccine administration for Juan Marcel Gonzales

Test Step Type: SUT_MANUAL
The EMR is able to document all attributes associated with the new vaccine administration.

Test Story

Description

 

 

The nurse administers the  inactivated influenza vaccine
• Documents all required information for each vaccine

 

 

Comments

No Comments

PreCondition

Order is placed for  inactivated influenza vaccine.

PostCondition

The  inactivated influenza vaccine administration is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source (Administration Notes) New immunization record (NIP001 00)
Value/Text for Vaccine Type  Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)
Date/Time of Start of Administration Current Date
Vaccine Administered Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161), FLUZONE QUADRIVALENT (NDC 49281-0514-25)
Administered Amount (of Vaccine) 0.25
Administered Units (of Measure) mL
Administering Provider Sandra Molina
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901
Lot Number D8043IN8855
Substance Expiration Date 8/25/2015
Substance Manufacturer Name Sanofi Pasteur (MVX PMC)
Completion Status CP
Route of Administration Intramuscular (NCIT C28161, HL70162: IM)
Administration Site Left Thigh (HL7 LT)
VFC Eligibility No

Notes to Testers

No Note

4.3. Mariela Gonzales Morales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

4.3.1. Enters a deferral for the vaccines due

Test Step Type: SUT_MANUAL
Enters a deferral for vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month.

Test Story

Description

The physician accesses the record for Mariela Gonzales Morales and:
• Enters a deferral for the vaccines due (Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus) due to medical reason, indicating low grade fever, and defers for 1 month

Comments

No Comment

PreCondition

Prior Immunization History loaded and reconciled from the Immunization Registry.  Vaccine forecast is available in the EMR indicating 5 vaccines are due: Hepatitis B, DTaP, Hib, Pneumococcal conjugate (PCV13) and Rotavirus

PostCondition

Vaccine deferral is recorded indicating the medical reason of low grade fever

Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.).  The system also stores that information in a structured way so it can be reported and analyzed as needed.

Evaluation Criteria

 EMR Records the following vaccine administration information:

Entered BY Sandra Molina
Ordering Provider Frank Smith
Entering Organization Shoreline Pediatrics
Vaccine Event information source New immunization record (NIP001 00)
Value/Text for Vaccine Type  hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
 pneumococcal conjugate vaccine, 13 valent (CVX 133)
rotavirus, live, monovalent vaccine (CVX 119)
Date/Time Vaccine not administered was recorded Current Date
Alert contraindication of fever
Substance/Treatment Deferral Start Date:Vaccination contraindication/precaution effective date (30946-8 LOINC) Current Date
Substance/Treatment Deferral End Date/Vaccination temporary contraindication/precaution expiration date (30944-3 LOINC) : Current Date +30 Days
Substance/Treatment Deferral Contraindication:  Vaccination contraindication/precaution (30945-0 LOINC): current fever with moderate-to-severe illness (PHVS_VaccinationContraindication_IIS - VXC23)
Completion Status:  NA
Date/Time Vaccine Deferral was recorded:  Current Date

Notes to Testers

No Note

5. Transmit Immunization Report

This test will consist of generating a Vaccine Update (VXU-Z22) report to the registry for three of the test patients, including updates for vaccines not given. NOTE: There is no Immunization Report in this test plan for Juana Maria Gonzales.

5.1. Juana Mariana Gonzales Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariana Gonzales.

Test Story

Description
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.

Comments
The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

PreCondition
The vaccines for the visit have been administered.

PostCondition
No PostCondition

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

5.1.1. Transmit the immunization report to the Immunization Registry

Test Step Type: SUT_INITIATOR
The EMR send the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

PreCondition

The vaccines for the visit have been administered.

PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Mariana Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Acosta Value-Test Case Fixed
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 200911231105 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System HL70005 Value-Test Case Fixed
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11[1] Patient Address
PID-11[1].1 Street Address
PID-11[1].1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
PID-11[1].1.2 Street Name
PID-11[1].1.3 Dwelling Number
PID-11[1].2 Other Designation
PID-11[1].3 City Stamford Value-Test Case Fixed
PID-11[1].4 State or Province CT Value-Test Case Fixed
PID-11[1].5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11[1].6 Country USA Value-Test Case Fixed
PID-11[1].7 Address Type L Value-Test Case Fixed
PID-11[2] Patient Address
PID-11[2].1 Street Address
PID-11[2].1.1 Street or Mailing Address 325 Shorline Drive
PID-11[2].1.2 Street Name
PID-11[2].1.3 Dwelling Number
PID-11[2].2 Other Designation
PID-11[2].3 City Stamford
PID-11[2].4 State or Province CT Value-Test Case Fixed
PID-11[2].5 Zip or Postal Code 06901
PID-11[2].6 Country
PID-11[2].7 Address Type BDL Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551212 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02
PD1-11.2 Text Reminder/Recall - any method
PD1-11.3 Name of Coding System HL70215
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20120701
PD1-18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Merida Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier GRP Value-Test Case Fixed
NK1-3.2 Text Grandparent Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551212 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lisa
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Jane
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Ricci
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Gina
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091123
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sirtis
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lisa
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100115
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Immunization
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK1
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101001
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101030
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK24
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120831
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2341
RXA-16 Substance Expiration Date
RXA-16.1 Time 20111130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2433
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS3255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS249
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110301
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20140831
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02
RXA-9.2 Text Historical information - from other provider
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D643QS8243
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140901
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M54K9245
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M55K3342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M75K4566
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M53K5534
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV2431
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101004
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4344
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02
RXA-9.2 Text Historical information - from other provider
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D335PV9644
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150519
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00
RXA-18.2 Text Parental decision
RXA-18.3 Name of Coding System NIP002
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status RE
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100121
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P243V3281
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P343V8321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V2164
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V58532
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110418
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV533
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV932
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101027
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9334IN9333
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131015
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 03
RXA-9.2 Text Historical information - from parents written record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Ricci
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Gina
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3423
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140701
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MED
RXA-17.2 Text MedImmune, LLC
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 149 Value-Test Case Fixed
RXA-5.2 Text influenza, live, intranasal, quadrivalent Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text FluMist Quadrivalent Value-Test Case Fixed
RXA-5.6 Name of Alternate Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.2 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3521 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150815 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MED Value-Test Case Fixed
RXA-17.2 Text MedImmune,LLC Value-Test Case Fixed
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121104
RXA-5 Administered Code
RXA-5.1 Identifier 149
RXA-5.2 Text influenza, live, intranasal, quadrivalent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FluMist Quadrivalent
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9553IN2243
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120430
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120124
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT48
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120911
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101023
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historical
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W27V7491
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W87V3452
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130413
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 94 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text ProQuad Value-Test Case Fixed
RXA-5.6 Name of Alternate Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W87V3687 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150715 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Value-Test Case Fixed
RXA-17.2 Text Merck Sharp \T\ Dohme Corp Value-Test Case Fixed
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38284
RXR-1.2 Text Nasal
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Nasal
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier BN
RXR-2.2 Text Bilateral Nares
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38284 Value-Test Case Fixed
RXR-1.2 Text Nasal Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-1.5 Alternate Text Nasal Value-Test Case Fixed
RXR-1.6 Name of Alternate Coding System HL70162 Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier BN
RXR-2.2 Text Bilateral Nares
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Value-Test Case Fixed
RXR-1.2 Text Subcutaneous Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-1.5 Alternate Text Subcutaneous Value-Test Case Fixed
RXR-1.6 Name of Alternate Coding System HL70162 Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Value-Test Case Fixed
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20140819
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9 Value-Test Case Fixed
OBX-3.2 Text VIS Publication Date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20100521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text VIS Presentation Date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text vaccine fund pgm elig cat Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 11/23/2009 11:05
Administrative Sex Female
Patient Address 1 4345 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race1 White
Ethnic Group Hispanic or Latino
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address1 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

5.1.2. Record an adverse reaction

Test Step Type: SUT_MANUAL
The Provider records in the EMR an adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose.

Test Story

Description

Following the vaccine administration, the patient's mother reports that the patient that evening had persistent, inconsolable crying lasting > 3 hours.

Comments

No Comments

PreCondition

The vaccinations for the visit have been administered.

PostCondition

The adverse reaction to the MMRV  of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.

Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria

Verify that vendor can record the adverse reaction of  persistent, inconsolable crying lasting > 3 hours within 48 hours of dose correctly and without omission

Notes to Testers

No Note

5.1.3. Transmit the updated vaccination report with adverse reaction to the registry

Test Step Type: SUT_INITIATOR
The EMR generates a Z22 Send Unsolicited Immunization Update Using a VXU correctly and without omission according to supplied test data.

Test Story

Description

The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is reported to the Immunization Registry using a Z22/VXU message.

Comments

No Comments

PreCondition

An adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.

PostCondition

The adverse reaction has been transmitted to the IIS.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales Value-Test Case Fixed
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Juana Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Mariana Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Acosta Value-Test Case Fixed
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 200912231105 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System HL70005 Value-Test Case Fixed
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11[1] Patient Address
PID-11[1].1 Street Address
PID-11[1].1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
PID-11[1].1.2 Street Name
PID-11[1].1.3 Dwelling Number
PID-11[1].2 Other Designation
PID-11[1].3 City Stamford Value-Test Case Fixed
PID-11[1].4 State or Province CT Value-Test Case Fixed
PID-11[1].5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11[1].6 Country USA Value-Test Case Fixed
PID-11[1].7 Address Type L Value-Test Case Fixed
PID-11[2] Patient Address
PID-11[2].1 Street Address
PID-11[2].1.1 Street or Mailing Address 325 Shorline Drive
PID-11[2].1.2 Street Name
PID-11[2].1.3 Dwelling Number
PID-11[2].2 Other Designation
PID-11[2].3 City Stamford
PID-11[2].4 State or Province CT Value-Test Case Fixed
PID-11[2].5 Zip or Postal Code 06901
PID-11[2].6 Country
PID-11[2].7 Address Type BDL Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551212 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02
PD1-11.2 Text Reminder/Recall - any method
PD1-11.3 Name of Coding System HL70215
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20120701
PD1-18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Merida Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier GRP Value-Test Case Fixed
NK1-3.2 Text Grandparent Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4345 Standish Way Value-Test Case Fixed
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06901 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551212 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lisa
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Jane
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Ricci
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Gina
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Herrera
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Carlos
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name F
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091123
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sirtis
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lisa
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100115
RXA-5 Administered Code
RXA-5.1 Identifier 45
RXA-5.2 Text hepatitis B vaccine, unspecified formulation
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text Historical Immunization
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK1
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101001
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101030
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK24
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120831
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 107
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2341
RXA-16 Substance Expiration Date
RXA-16.1 Time 20111130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2433
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS3255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101201
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS249
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110301
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20140831
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02
RXA-9.2 Text Historical information - from other provider
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D643QS8243
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140901
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M54K9245
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M55K3342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M75K4566
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M53K5534
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV2431
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101004
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4344
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 02
RXA-9.2 Text Historical information - from other provider
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Casera
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Linda
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D335PV9644
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150519
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text poliovirus vaccine, inactivated
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00
RXA-18.2 Text Parental decision
RXA-18.3 Name of Coding System NIP002
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status RE
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100121
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P243V3281
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P343V8321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100522
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V2164
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20110221
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V58532
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110418
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV533
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100323
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text rotavirus, live, monovalent vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV932
RXA-16 Substance Expiration Date
RXA-16.1 Time 20100510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100925
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101027
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8734
RXA-16 Substance Expiration Date
RXA-16.1 Time 20110312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111002
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9334IN9333
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131015
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 03
RXA-9.2 Text Historical information - from parents written record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Ricci
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Gina
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3423
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140701
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MED
RXA-17.2 Text MedImmune, LLC
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 149
RXA-5.2 Text influenza, live, intranasal, quadrivalent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FluMist Quadrivalent
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.2
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text New immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 8L4B3521
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150815
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MED
RXA-17.2 Text MedImmune,LLC
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121104
RXA-5 Administered Code
RXA-5.1 Identifier 149
RXA-5.2 Text influenza, live, intranasal, quadrivalent
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FluMist Quadrivalent
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9553IN2243
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120430
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111123
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120124
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120523
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT48
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120911
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20101023
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historical
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W27V7491
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W87V3452
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130413
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp \T\ Dohme Corp
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 94 Value-Test Case Fixed
RXA-5.2 Text measles, mumps, rubella, and varicella virus vaccine Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text ProQuad Value-Test Case Fixed
RXA-5.6 Name of Alternate Coding System NDC Value-Test Case Fixed
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New immunization record Value-Test Case Fixed
RXA-9.3 Name of Coding System NIP001 Value-Test Case Fixed
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina Value-Test Case Fixed
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra Value-Test Case Fixed
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W87V3687 Value-Test Case Fixed
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150715 Value-Test Case Fixed
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Value-Test Case Fixed
RXA-17.2 Text Merck Sharp \T\ Dohme Corp Value-Test Case Fixed
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38284
RXR-1.2 Text Nasal
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Nasal
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier BN
RXR-2.2 Text Bilateral Nares
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38284
RXR-1.2 Text Nasal
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Nasal
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier BN
RXR-2.2 Text Bilateral Nares
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299
RXR-1.2 Text Subcutaneous
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text Subcutaneous
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Value-Test Case Fixed
RXR-1.2 Text Subcutaneous Value-Test Case Fixed
RXR-1.3 Name of Coding System NCIT Value-Test Case Fixed
RXR-1.5 Alternate Text Subcutaneous Value-Test Case Fixed
RXR-1.6 Name of Alternate Coding System HL70162 Value-Test Case Fixed
RXR-2 Administration Site
RXR-2.1 Identifier LD Value-Test Case Fixed
RXR-2.2 Text Left Deltoid Value-Test Case Fixed
RXR-2.3 Name of Coding System HL70163 Value-Test Case Fixed
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1
OBX-3.2 Text Reaction
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC12
OBX-5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20100522
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20140819
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20100521
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC elig
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 31044-1 Value-Test Case Fixed
OBX-3.2 Text Reaction Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Identifier VXC9
OBX-5.2 Text persistent, inconsolable crying lasting > 3 hours within 48 hours of dose
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 12/23/2009 11:05
Administrative Sex Female
Patient Address 1 4345 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race1 White
Ethnic Group Hispanic or Latino
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address1 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig
vaccine fund pgm elig cat Not VFC elig
Reaction persistent, inconsolable crying lasting > 3 hours within 48 hours of dose

5.2. Juan Marcel Gonzales Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juan Marcel Gonzales.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

5.2.1. Transmit the Immunization Report for Juan Marcel Gonzales

Test Step Type: SUT_INITIATOR
The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all newly administered vaccines in any order. The report may include the information imported from the IIS.

PreCondition

The vaccines for the visit have been administered.

PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.
The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Gonzales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Juan Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Morales Value-Test Case Fixed
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201111231100 Value-Test Case Fixed
PID-8 Administrative Sex M Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System HL70005 Value-Test Case Fixed
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 4623 Standish Way Value-Test Case Fixed
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Stamford Value-Test Case Fixed
PID-11.4 State or Province CT Value-Test Case Fixed
PID-11.5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11.6 Country USA Value-Test Case Fixed
PID-11.7 Address Type L Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551213 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02
PD1-11.2 Text Reminder/Recall - any method
PD1-11.3 Name of Coding System HL70215
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20120701
PD1-18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Gonzales Value-Test Case Fixed
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Manuel Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Marcel Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier FTH Value-Test Case Fixed
NK1-3.2 Text Father Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063 Value-Test Case Fixed
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4623 Standish Way Value-Test Case Fixed
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06903 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551213 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lisa
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Jane
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Martinez
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name J.
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Rodriguez
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name J.
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier OP
ORC-17.2 Text Oceanview Pediatrics
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111123
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK34
RXA-16 Substance Expiration Date
RXA-16.1 Time 20111214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20111223
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6352FK2
RXA-16 Substance Expiration Date
RXA-16.1 Time 20111001
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hepatitis B
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK26
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150825
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2342
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS2434
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120904
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS250
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140103
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130220
RXA-5 Administered Code
RXA-5.1 Identifier 106
RXA-5.2 Text DTaP
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text DAPTACEL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D409QS250
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140103
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M54K9255
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120324
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M55K3343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20121030
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120512
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M75K4577
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120523
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120222
RXA-5 Administered Code
RXA-5.1 Identifier 49
RXA-5.2 Text Hib
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PedvaxHIB
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7M53K5535
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120222
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV2444
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120410
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 10
RXA-5.2 Text Polio (IPV)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text IPOL
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D333PV4343
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120323
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text MSanofi Pasteur Inc.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P243V3321
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120130
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P343V8445
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120330
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120521
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V2175
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120830
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 133
RXA-5.2 Text Pneumococcal conjugate (PCV13)
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text PREVNAR 13
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number P853V58544
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130118
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR
RXA-17.2 Text Pfizer, Inc
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121122
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV543
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120322
RXA-5 Administered Code
RXA-5.1 Identifier 119
RXA-5.2 Text Rotavirus
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ROTARIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RV933
RXA-16 Substance Expiration Date
RXA-16.1 Time 20120510
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20120922
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8738
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20121022
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8798
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130312
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131030
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D9334IN9433
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140522
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 161
RXA-5.2 Text Influenza
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text FLUZONE QUADRIVALENT
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 0.25
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Molina
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Sandra
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number D8043IN8855
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150828
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC
RXA-17.2 Text Sanofi Pasteur
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130521
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text Hepatitis A
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT35
RXA-16 Substance Expiration Date
RXA-16.1 Time 20140104
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131201
RXA-5 Administered Code
RXA-5.1 Identifier 83
RXA-5.2 Text Hepatitis A
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text HAVRIX
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6359RT47
RXA-16 Substance Expiration Date
RXA-16.1 Time 20130911
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20130112
RXA-5 Administered Code
RXA-5.1 Identifier 94
RXA-5.2 Text MMR and Varicella
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ProQuad
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Martinez
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name J.
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 7W27V7632
RXA-16 Substance Expiration Date
RXA-16.1 Time 20161215
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD
RXA-17.2 Text Merck Sharp and Dohme Corp.
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Thigh Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RT
RXR-2.2 Text Right Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier RD
RXR-2.2 Text Right Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LD
RXR-2.2 Text Left Deltoid
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text SC
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text SC
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20120202
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29768-9
OBX-3.2 Text VIS Publication Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20140819
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7
OBX-3.2 Text VIS Presentation Date
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7
OBX-3.2 Text vaccine fund pgm elig cat
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juan Marcel Gonzales
Mother's Maiden Name Anita Morales
ID Number 123456 987633
Date/Time of Birth 11/23/2011 11:00
Administrative Sex Male
Patient Address 1 4623 Standish Way Stamford CT 06903 USA
Local Number (203)555-1213
Race1 White
Ethnic Group Hispanic or Latino
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Manuel Marcel Gonzales
Relationship Father
Address1 4623 Standish Way Stamford CT 06903
Phone Number (203)555-1213

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code Hepatitis B
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6332FK34
Substance Expiration Date 12/14/2011
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Code Hepatitis B
Date/Time Start of Administration 12/23/2011
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6352FK2
Substance Expiration Date 10/01/2011
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Hepatitis B
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number 6332FK26
Substance Expiration Date 08/25/2015
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 02/02/2012
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information
Element Data
Administered Code DTaP
Date/Time Start of Administration 01/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS2342
Substance Expiration Date 11/30/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code DTaP
Date/Time Start of Administration 03/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS2434
Substance Expiration Date 09/04/2012
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code DTaP
Date/Time Start of Administration 05/21/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS250
Substance Expiration Date 01/03/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code DTaP
Date/Time Start of Administration 02/20/2013
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D409QS250
Substance Expiration Date 01/03/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Hib
Date/Time Start of Administration 01/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M54K9255
Substance Expiration Date 03/24/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Hib
Date/Time Start of Administration 03/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M55K3343
Substance Expiration Date 10/30/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Hib
Date/Time Start of Administration 05/12/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M75K4577
Substance Expiration Date 05/23/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Hib
Date/Time Start of Administration 02/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7M53K5535
Substance Expiration Date 02/22/2012
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Polio (IPV)
Date/Time Start of Administration 01/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV2444
Substance Expiration Date 04/10/2012
Substance Manufacturer Name MSanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Polio (IPV)
Date/Time Start of Administration 03/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV4343
Substance Expiration Date 03/23/2012
Substance Manufacturer Name MSanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Polio (IPV)
Date/Time Start of Administration 05/21/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D333PV4343
Substance Expiration Date 03/23/2012
Substance Manufacturer Name MSanofi Pasteur Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 01/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P243V3321
Substance Expiration Date 01/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 03/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P343V8445
Substance Expiration Date 03/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 05/21/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P853V2175
Substance Expiration Date 08/30/2012
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Pneumococcal conjugate (PCV13)
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number P853V58544
Substance Expiration Date 01/18/2013
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Rotavirus
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RV543
Substance Expiration Date 02/15/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Rotavirus
Date/Time Start of Administration 03/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RV933
Substance Expiration Date 05/10/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Thigh Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Influenza
Date/Time Start of Administration 09/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D8043IN8738
Substance Expiration Date 03/12/2013
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Influenza
Date/Time Start of Administration 10/22/2012
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D8043IN8798
Substance Expiration Date 03/12/2013
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Influenza
Date/Time Start of Administration 10/30/2013
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number D9334IN9433
Substance Expiration Date 05/22/2014
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Influenza
Date/Time Start of Administration 07/15/2015
Administered Amount 0.25
Administered Units
Administration Notes
Administering Provider Sandra Molina
Substance Lot Number D8043IN8855
Substance Expiration Date 08/28/2015
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information
Element Data
Administered Code Hepatitis A
Date/Time Start of Administration 05/21/2013
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RT35
Substance Expiration Date 01/04/2014
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code Hepatitis A
Date/Time Start of Administration 12/01/2013
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 6359RT47
Substance Expiration Date 09/11/2013
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

Vaccine Administration Information
Element Data
Administered Code MMR and Varicella
Date/Time Start of Administration 01/12/2013
Administered Amount 999
Administered Units
Administration Notes
Administering Provider J. Martinez
Substance Lot Number 7W27V7632
Substance Expiration Date 12/15/2016
Substance Manufacturer Name Merck Sharp and Dohme Corp.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J. Martinez
Ordered By J. Rodriguez

5.3. Mariela Gonzales Morales Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Mariela Gonzales Morales.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

5.3.1. Transmit the Immunization Report for Mariela Gonzales Morales

Test Step Type: SUT_INITIATOR
The EMR sends the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes the vaccine deferral and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes the vaccine deferrals. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all vaccine deferrals recorded in the EMR in any order. The report may include the information imported from the IIS

PreCondition

The vaccines for the visit have been administered.

PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content. The message must contain all deferrals recorded in the EMR. Current Date is expected for the Non-Administration date and deferral date.

Notes to Testers

No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID Test EHR Application
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID X68
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST Test Iz Reg
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20120701082240-0500
MSH-9 Message Type
MSH-9.1 Message Code VXU
MSH-9.2 Trigger Event V04
MSH-9.3 Message Structure VXU_V04
MSH-10 Message Control ID NIST-IZ-001.00
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type ER
MSH-16 Application Acknowledgment Type AL
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code
MSH-22.10 Organization Identifier
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code
MSH-23.10 Organization Identifier

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 123456
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID MYEHR
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 987633
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MYIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Morales
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Mariela Value-Test Case Fixed
PID-5.3 Second and Further Given Names or Initials Thereof Gonzales Value-Test Case Fixed
PID-5.7 Name Type Code L Value-Test Case Fixed
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Gonzales Value-Test Case Fixed
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Test Case Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 201505301115 Value-Test Case Fixed
PID-8 Administrative Sex F Value-Test Case Fixed
PID-10 Race
PID-10.1 Identifier 2106-3 Value-Test Case Fixed
PID-10.2 Text White Value-Test Case Fixed
PID-10.3 Name of Coding System HL70005 Value-Test Case Fixed
PID-10.5 Alternate Text
PID-10.6 Name of Alternate Coding System
PID-11[1] Patient Address
PID-11[1].1 Street Address
PID-11[1].1.1 Street or Mailing Address 3321 Standish Way Value-Test Case Fixed
PID-11[1].1.2 Street Name
PID-11[1].1.3 Dwelling Number
PID-11[1].2 Other Designation
PID-11[1].3 City Stamford Value-Test Case Fixed
PID-11[1].4 State or Province CT Value-Test Case Fixed
PID-11[1].5 Zip or Postal Code 06903 Value-Test Case Fixed
PID-11[1].6 Country USA Value-Test Case Fixed
PID-11[1].7 Address Type L Value-Test Case Fixed
PID-11[2] Patient Address
PID-11[2].1 Street Address
PID-11[2].1.1 Street or Mailing Address 325 Shorline Drive
PID-11[2].1.2 Street Name
PID-11[2].1.3 Dwelling Number
PID-11[2].2 Other Designation
PID-11[2].3 City Stamford
PID-11[2].4 State or Province CT Value-Test Case Fixed
PID-11[2].5 Zip or Postal Code 06901
PID-11[2].6 Country
PID-11[2].7 Address Type BDL Value-Test Case Fixed
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Value-Test Case Fixed
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address
PID-13.6 Area/City Code 203 Value-Test Case Fixed
PID-13.7 Local Number 5551214 Value-Test Case Fixed
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Value-Test Case Fixed
PID-22.2 Text Hispanic or Latino Value-Test Case Fixed
PID-22.3 Name of Coding System CDCREC Value-Test Case Fixed
PID-22.5 Alternate Text
PID-22.6 Name of Alternate Coding System
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-29 Patient Death Date and Time
PID-29.1 Time
PID-30 Patient Death Indicator

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02
PD1-11.2 Text Reminder/Recall - any method
PD1-11.3 Name of Coding System HL70215
PD1-11.5 Alternate Text
PD1-11.6 Name of Alternate Coding System
PD1-12 Protection Indicator
PD1-13 Protection Indicator Effective Date
PD1-16 Immunization Registry Status A
PD1-17 Immunization Registry Status Effective Date 20120701
PD1-18 Publicity Code Effective Date 20120701

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Morales Value-Test Case Fixed
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Joanna Value-Test Case Fixed
NK1-2.3 Second and Further Given Names or Initials Thereof Gonzales Value-Test Case Fixed
NK1-2.7 Name Type Code L Value-Test Case Fixed
NK1-3 Relationship
NK1-3.1 Identifier MTH Value-Test Case Fixed
NK1-3.2 Text Mother Value-Test Case Fixed
NK1-3.3 Name of Coding System HL70063
NK1-3.5 Alternate Text
NK1-3.6 Name of Alternate Coding System
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 4623 Standish Way Value-Test Case Fixed
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation
NK1-4.3 City Stamford Value-Test Case Fixed
NK1-4.4 State or Province CT Value-Test Case Fixed
NK1-4.5 Zip or Postal Code 06903 Value-Test Case Fixed
NK1-4.6 Country
NK1-4.7 Address Type L Value-Test Case Fixed
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Value-Test Case Fixed
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address
NK1-5.6 Area/City Code 203 Value-Test Case Fixed
NK1-5.7 Local Number 5551213 Value-Test Case Fixed

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Sirtis Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lisa
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Carter
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Jane
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SH
ORC-17.2 Text Shoreline Hospital
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Value-Test Case Fixed
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-10 Entered By
ORC-10.1 ID Number
ORC-10.2 Family Name
ORC-10.2.1 Surname Molina Value-Test Case Fixed
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Sandra Value-Test Case Fixed
ORC-10.4 Second and Further Given Names or Initials Thereof
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code
ORC-10.12 Check Digit Scheme
ORC-10.13 Identifier Type Code
ORC-12 Ordering Provider
ORC-12.1 ID Number
ORC-12.2 Family Name
ORC-12.2.1 Surname Smith Value-Test Case Fixed
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Frank Value-Test Case Fixed
ORC-12.4 Second and Further Given Names or Initials Thereof
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L
ORC-12.12 Check Digit Scheme
ORC-12.13 Identifier Type Code
ORC-17 Entering Organization
ORC-17.1 Identifier SP
ORC-17.2 Text Shoreline Pediatrics Value-Test Case Fixed
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150530
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text ENGERIX-B
RXA-5.6 Name of Alternate Coding System NDC
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 08
RXA-9.2 Text Historical information - from public agency
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sirtis
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lisa
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number 6332FK33
RXA-16 Substance Expiration Date
RXA-16.1 Time 20101214
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB
RXA-17.2 Text GlaxoSmithKline Biologicals SA
RXA-17.3 Name of Coding System MVX
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text hepatitis B vaccine, unspecified formulation Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 107 Value-Test Case Fixed
RXA-5.2 Text DTaP, unspecified formulation Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 08 Value-Test Case Fixed
RXA-5.2 Text Hib Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 152 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal Conjugate, unspecified formulation Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150715
RXA-5 Administered Code
RXA-5.1 Identifier 122 Value-Test Case Fixed
RXA-5.2 Text rotavirus, unspecified formulation Value-Test Case Fixed
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-16.1 Time
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier
RXA-17.2 Text
RXA-17.3 Name of Coding System
RXA-17.5 Alternate Text
RXA-17.6 Name of Alternate Coding System
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA Value-Test Case Fixed
RXA-21 Action Code - RXA A

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text IM
RXR-1.6 Name of Alternate Coding System HL70162
RXR-2 Administration Site
RXR-2.1 Identifier LT
RXR-2.2 Text Left Thigh
RXR-2.3 Name of Coding System HL70163
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3 Value-Test Case Fixed
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150815
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3 Value-Test Case Fixed
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150815
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3 Value-Test Case Fixed
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150815
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3 Value-Test Case Fixed
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150815
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30945-0 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30946-8 Value-Test Case Fixed
OBX-3.2 Text Vaccination contraindication/precaution effective date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150715
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type TS
OBX-3 Observation Identifier
OBX-3.1 Identifier 30944-3 Value-Test Case Fixed
OBX-3.2 Text Vaccination temporary contraindication/precaution expiration date Value-Test Case Fixed
OBX-3.3 Name of Coding System LN Value-Test Case Fixed
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-5.1 Time 20150815
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150715
OBX-17 Observation Method
OBX-17.1 Identifier
OBX-17.2 Text
OBX-17.3 Name of Coding System
OBX-17.5 Alternate Text
OBX-17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Mariela Gonzales Morales
Mother's Maiden Name Joanna Gonzales
ID Number 123456 987633
Date/Time of Birth 05/30/2015 11:15
Administrative Sex Female
Patient Address 1 3321 Standish Way Stamford CT 06903 USA
Patient Address 2 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1214
Race1 White
Ethnic Group Hispanic or Latino
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Gonzales Morales
Relationship Mother
Address1 4623 Standish Way Stamford CT 06903
Phone Number (203)555-1213

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 05/30/2015
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 07/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status NA
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 07/15/2015
Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information
Element Data
Administered Code DTaP, unspecified formulation
Date/Time Start of Administration 07/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status NA
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 07/15/2015
Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information
Element Data
Administered Code Hib
Date/Time Start of Administration 07/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status NA
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 07/15/2015
Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information
Element Data
Administered Code Pneumococcal Conjugate, unspecified formulation
Date/Time Start of Administration 07/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status NA
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 07/15/2015
Vaccination temporary contraindication/precaution expiration date 08/15/2015

Vaccine Administration Information
Element Data
Administered Code rotavirus, unspecified formulation
Date/Time Start of Administration 07/15/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status NA
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Element Data
Vaccination contraindication current fever with moderate-to-severe illness
Vaccination contraindication/precaution effective date 07/15/2015
Vaccination temporary contraindication/precaution expiration date 08/15/2015

6. Display Immunization Report

This test will consist of generating and displaying a human readable immunization report for the patient showing immunization history, upcoming vaccines due.

6.1. Juana Mariana Gonzales Display Immunization Report

Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Test Story

Description
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments
No Comments

PreCondition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition
The patient/parent has been provided a patient immunization history report.

Test Objectives
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

6.1.1. Produce an immunization report for Juana Mariana Gonzales including all history

Test Step Type: SUT_MANUAL
The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria

The following patient demographics are displayed:

 
Patient Identifier Number:         Vendor Assigned
Patient Identifier Type Code: Vendor Assigned
Patient Name:         Juana Mariana Gonzales
Date/Time of Birth:         12/23/2009 11:05am
 
Sex:                 Female
Patient Address:         4345 Standish Way, Stamford, CT, 06903
Multiple Birth:         N
Birth Order:         NA
 
The following Vaccination History is displayed:
 
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 12/23/2009
Additional Observations: None
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shorline Drive, 
Stamford Connecticut 06901
Lot#: 6332FK33
Exp Date: 12/14/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 1/15/2010
Additional Observations: None
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Frank Smith
Entered By: Sandra Molina
Entering Organization: Shoreline Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shorline Drive, 
Stamford Connecticut 06901
Lot#: 6352FK1
Exp Date: 10/1/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 10/30/2010
Additional Observations: None
Dose #: 3
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6352FK24
Exp Date: 8/31/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 1/22/2010
Additional Observations: None
Dose #: 1
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS2341
Exp Date: 11/30/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)
Date Administered: 3/23/2010
Additional Observations: 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
Dose #: 2
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS2433
Exp Date: 9/4/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/22/2010
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS3255
Exp Date: 12/1/2010
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 2/21/2011
Additional Observations:
Dose #: 4
Doses in Series: 5
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D409QS249
Exp Date: 3/1/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M54K9245
Exp Date: 3/24/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M55K3342
Exp Date: 10/30/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 5/22/2010
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M75K4566
Exp Date: 5/23/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 2/21/2011
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7M53K5534
Exp Date: 2/22/2011
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D333PV2431
Exp Date: 10/4/2010
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D333PV4344
Exp Date: 3/23/2010
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P243V3281
Exp Date: 1/30/2010
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P343V8321
Exp Date: 3/30/2010
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 5/22/2010
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P853V2164
Exp Date: 8/30/2010
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 2/21/2011
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: P853V58532
Exp Date: 4/18/2011
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 1/22/2010
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RV533
Exp Date: 2/15/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 3/23/2010
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RV932
Exp Date: 5/10/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 9/25/2010
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D8043IN8734
Exp Date: 3/12/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/27/2010
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D8043IN8734
Exp Date: 3/12/2011
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/2/2011
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D9334IN9333
Exp Date: 5/22/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 11/4/2012
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: D9553IN2243
Exp Date: 4/30/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: influenza, unspecified formulation
Administered: influenza, live, intranasal, quadrivalent (CVX 149)
FluMist Quadrivalent (NDC 66019-0301-10)"
Date Administered: Current Date
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .2 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 8L4B3521
Exp Date: 7/15/2015
Manufacturer: MedImmune,LLC (MVX MED)
Route: Nasal (NCIT C38284), Nasal (HL70162 NS)
Site:
 
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 11/23/2011
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RT33
Exp Date: 1/4/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Deltoid (HL7 RD)
 
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 5/23/2012
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 6359RT48
Exp Date: 9/11/2012
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: 10/23/2010
Additional Observations:
Dose #:
Doses in Series: 2
Valid Dose: N
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7W27V7491
Exp Date: 12/15/2010
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Carlos Herrera
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 333 Oceanview Lane, Stamford Connecticut 06901
Lot#: 7W87V3452
Exp Date: 4/13/2013
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: Current Date
Additional Observations: Reaction (LOINC 31044-1)/fever of >40.5C (105F) within 48 hours of dose (CDCPHINVS VXC12)
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 7W87V3687
Exp Date: 7/15/2015
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
 
The Following Vaccine Forecast is displayed:
 
Vaccine Group: IPV
Due Date: 11/22/2013
Earliest Date to Give: 11/22/2013
Latest Date to Give: 11/22/2015
Overdue Date: 11/23/2015
Immunization Schedule: ACIP
 
 
Vaccine Group: influenza, unspecified formulation
Due Date: 10/21/2016
Earliest Date to Give: 9/1/2016
Latest Date to Give: 2/29/2017
Overdue Date: 3/1/3027
Immunization Schedule: ACIP
 

Notes to Testers

No Note

6.2. Juan Marcel Gonzales Display Immunization Report

Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Test Story

Description
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments
No Comments

PreCondition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition
The patient/parent has been provided a patient immunization history report.

Test Objectives
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

6.2.1. Produce an immunization report for Juan Marcel Gonzales including all history

Test Step Type: SUT_MANUAL
The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria
The following patient demographics are displayed:
Patient Identifier Number: Vendor Assigned
Patient Identifier Type Code: Vendor Assigned
Patient Name: Juan Marcel Gonzales
Date/Time of Birth: 11/23/2011 11:00am
Sex: Male
Patient Address: 4623 Standish Way, Stamford, CT 06903
Multiple Birth: N
Birth Order: NA
 
The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 11/23/2011
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shorline Drive, 
Stamford Connecticut 06901
Lot#: 6332FK34
Exp Date: 12/14/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 12/23/2013
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6352FK2
Exp Date: 10/1/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: Current Date
Additional Observations:
Dose #: 3
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: 6332FK26
Exp Date: 8/25/2015
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL70162 LD)
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS2342
Exp Date: 11/30/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS2434
Exp Date: 9/4/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS3256
Exp Date: 12/1/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
 
Vaccine Group: diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Administered: diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106)
DAPTACEL (NDC 49281-0286-01)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 5
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D409QS3256
Exp Date: 12/1/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M54K9255
Exp Date: 3/24/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M55K3343
Exp Date: 10/30/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M75K4577
Exp Date: 5/23/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: Hib, unspecified formulation
Administered: Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49)
PedvaxHIB (NDC 00006-4897-00)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7M53K5535
Exp Date: 2/22/2012
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D333PV2444
Exp Date: 10/4/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D333PV4343
Exp Date: 3/23/2012
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: poliovirus vaccine, inactivated
Administered: poliovirus vaccine, inactivated (CVX 10)
IPOL (NDC 49281-0860-55)
Date Administered: 5/21/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D335PV9654
Exp Date: 2/22/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P243V3321
Exp Date: 1/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P343V8445
Exp Date: 3/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 5/21/2012
Additional Observations:
Dose #: 3
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P853V2175
Exp Date: 8/30/2012
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: pneumococcal, unspecified formulation
Administered: pneumococcal conjugate vaccine, 13 valent (CVX 133)
PREVNAR 13 (NDC 00005-1971-05)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 4
Doses in Series: 4
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: P853V58544
Exp Date: 4/18/2013
Manufacturer: Pfizer, Inc (MVX PFR)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 1/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RV533
Exp Date: 2/15/2010
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: rotavirus, unspecified formulation
Administered: rotavirus, live, monovalent vaccine (CVX 119)
ROTARIX (NDC 58160-0854-52)"
Date Administered: 3/22/2012
Additional Observations:
Dose #: 2
Doses in Series: 3
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: 1 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RV932
Exp Date: 5/10/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 9/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8734
Exp Date: 3/12/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/20/2012
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8798
Exp Date: 3/12/2013
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Thigh (HL7 RT)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: 10/30/2013
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: D8043IN8734
Exp Date: 5/22/2014
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: influenza, unspecified formulation
Administered: Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161)
FLUZONE QUADRIVALENT (NDC 49281-0514-25)"
Date Administered: Current Date
Additional Observations:
Dose #:
Doses in Series:
Valid Dose:
Ordering Provider: Sandra Molina
Entered By: Frank Smith
Entering Organization: Oceanview Pediatrics
Administered Amt: .25 mL
Administering Provider: Sandra Molina
Administered at Location: 400 Shoreline Drive, Stamford Connecticut 06901
Lot#: D8043IN8855
Exp Date: 7/28/2015
Manufacturer: Sanofi Pasteur Inc (MVX PMC)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 5/21/2013
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RT35
Exp Date: 1/4/2014
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Right Deltoid (HL7 RD)
 
Vaccine Group: Hep A, unspecified formulation
Administered: hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83)
HAVRIX (NDC 58160-0825-52)"
Date Administered: 12/1/2013
Additional Observations:
Dose #: 2
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 6359RT47
Exp Date: 9/11/2013
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Deltoid (HL7 LD)
 
Vaccine Group: MMRV
Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94)
ProQuad (NDC 00006-4999-00)"
Date Administered: 11/22/2012
Additional Observations:
Dose #: 1
Doses in Series: 2
Valid Dose: Y
Ordering Provider: J. Rodriguez
Entered By: J. Martinez
Entering Organization: Oceanview Pediatrics
Administered Amt: .05 mL
Administering Provider: J. Martinez
Administered at Location: 4253 Standish Way, Stamford Connecticut 06903
Lot#: 7W27V7632
Exp Date: 12/15/2016
Manufacturer: Merck Sharp & Dohme Corp (MVX MSD)
 
Route: Subcutaneous (NCIT C38299, HL70162: SC)
Site: Left Thigh (HL7 LT)
 
The Following Vaccine Forecast is displayed:
Vaccine Group: Dtap
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP
 
Vaccine Group: IPV
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP
 
Vaccine Group: Influenza
Due Date: 10/22/2015
Earliest Date to Give: 9/1/2015
Latest Date to Give: 1/31/2016
Overdue Date: 2/1/2016
Immunization Schedule: ACIP
 
Vaccine Group: MMR
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP
 
Vaccine Group: Varicella
Due Date: 11/22/2015
Earliest Date to Give: 11/22/2015
Latest Date to Give: 11/21/2017
Overdue Date: 11/22/2017
Immunization Schedule: ACIP

Notes to Testers

No Note

6.3. Mariana Gonzales Morales Display Immunization Report

Produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Test Story

Description
Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments
No Comments

PreCondition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition
The patient/parent has been provided a patient immunization history report.

Test Objectives
Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

6.3.1. Produce an immunization report for Juan Marcel Gonzales including all history

Test Step Type: SUT_MANUAL
The EMR is used to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.).

Test Story

Description

Following the vaccination visit, the provider uses the EMR to produce an immunization report for the patient including all history (the report can be provided in various formats - e.g., print, send to patient portal, etc.)

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. New vaccinations have been administered.

PostCondition

The patient/parent has been provided a patient immunization history report.

Test Objectives

Produce Standard Patient Immunization History Report: The EHR or other clinical software system produces a report of a patient's immunization history that is appropriate for various entities, such as schools and day-care centers.

Evaluation Criteria
The following patient demographics are displayed:
Patient Identifier Number: Vendor Supplied
Patient Identifier Type Code: Vendor Supplied
Patient Name: Mariela Gonzales Morales
Date/Time of Birth: 03/30/2015 11:00am
Sex: Female
Patient Address: 3321 Standish Way, Stamford, CT 06903
Multiple Birth: Y
Birth Order: 1
 
The following Vaccination History is displayed:
Vaccine Group: Hep B Peds NOS
Administered: hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)
ENGERIX-B (NDC 58160-0820-11)"
Date Administered: 11/23/2011
Additional Observations:
Dose #: 1
Doses in Series: 3
Valid Dose: Y
Ordering Provider: Jane Carter
Entered By: Lisa Sirtis
Entering Organization: Shoreline Hospital
Administered Amt: .05 mL
Administering Provider: Jane Carter
Administered at Location: 325 Shorline Drive, 
Stamford Connecticut 06901
Lot#: 6332FK34
Exp Date: 12/14/2011
Manufacturer: GlaxoSmithKline Biologicals SA (MVX SKB)
Route: Intramuscular (NCIT C28161, HL70162: IM)
Site: Left Thigh (HL7 LT)
 
The Following Vaccine Forecast is displayed:
Vaccine Group: Hep B Peds NOS
Due Date: 6/29/2015
Earliest Date to Give: 6/29/2015
Latest Date to Give: 7/29/2015
Overdue Date: 7/30/2015
Immunization Schedule: ACIP
 
Vaccine Group: Dtap
Due Date: 7/29/2015
Earliest Date to Give: 29-Jul-15
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
 
Vaccine Group: Hib
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
 
Vaccine Group: IPV
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
 
Vaccine Group: Pneumococcal conjugate
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
 
Vaccine Group: Rotavirus
Due Date: 7/29/2015
Earliest Date to Give: 7/29/2015
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
 
Vaccine Group: Influenza
Due Date: Nov 26, 2015 or later 
later
Earliest Date to Give: Nov 26, 2015
 
Latest Date to Give:
Overdue Date:
Immunization Schedule: ACIP
 
Vaccine Group: HepA
Due Date: 5/29/2016
Earliest Date to Give: 5/29/2016
Latest Date to Give: 5/29/2017
Overdue Date: 5/30/2017
Immunization Schedule: ACIP
 
Vaccine Group: MMR
Due Date: 5/29/2016
Earliest Date to Give: 5/29/2016
Latest Date to Give: 8/27/2016
Overdue Date: 8/28/2016
Immunization Schedule: ACIP
 
Vaccine Group: Varicella
Due Date: 5/29/2016
Earliest Date to Give: 5/29/2016
Latest Date to Give: 8/27/2016
Overdue Date: 8/28/2016
Immunization Schedule: ACIP
 

Notes to Testers

No Note

7. Cohort Report

This test will consist of generating a cohort report to list all patients who are overdue for immunizations showing all overdue immunizations with the associated due/overdue dates.

7.1. Overdue Immunizations

List all patients who are overdue for immunizations showing all overdue immunizations.

Test Story

Description

The provider periodically uses the EMR to identify the cohort of patients that are overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR.

PostCondition

The Cohort report for all patients that are overdue for immunizations is available to the provider through the EMR.

Test Objectives

Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data.

Evaluation Criteria

The following patient information is provided on the cohort report:

 
Patient Name   Mariela Gonzales Morales
Preferred Contact Method   Phone
Contact information using preferred contact (email, text, phone, mailing address)   (203) 555-1214
Patient Identifier Number   Vendor Supplied
Patient Identifier Type Code      Vendor Supplied
Date/Time of Birth   5/30/2015 11am
Sex  Female
Vaccine Group  Hep B Peds NOS
Latest Date to Give  5/29/15
Overdue Date  5/29/15
Dose #  2
Dose in Series  3
Link to full record  Vendor Supplied
   
Patient Name  Juana Maria Gonzales Morales
Preferred Contact Method  Phone
Contact information using preferred contact (email, text, phone, mailing address)   (203) 555-1214
Patient Identifier Number   Vendor Supplied
Patient Identifier Type Code   Vendor Supplied
Date/Time of Birth   5/30/2015 11:15am
Sex   Female
Vaccine Group   Hep B Peds NOS
Latest Date to Give   5/29/15
Overdue Date   5/29/15
Dose #     2
Dose in Series    3
Link to full record   Vendor Supplied

Notes to Testers

No Note

7.1.1. Produce Overdue Immunizations Cohort Report

Test Step Type: SUT_MANUAL
The provider uses the EMR to create a report for all patient vaccinations overdue with the contact information.

Test Story

Description
The provider periodically uses the EMR to identify the cohort of patients that are overdue for immunizations along with their contact information in order to send reminder notifications to the patients/parents.
 

Comments

No Comments

PreCondition
Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR. The vaccine forecast is available to the EMR.
 

PostCondition

The Cohort report for all patients that are overdue for immunizations is available to the provider through the EMR.

Test Objectives

Produce Population-Level Report: The EHR or other clinical system generates aggregate, population-level reports based on known patient immunization data.

Evaluation Criteria

The following patient information is provided on the cohort report:

 
Patient Name   Mariela Gonzales Morales
Preferred Contact Method   Phone
Contact information using preferred contact (email, text, phone, mailing address)   (203) 555-1214
Patient Identifier Number   Vendor Supplied
Patient Identifier Type Code      Vendor Supplied
Date/Time of Birth   3/30/2015 11am
Sex  Female
Vaccine Group  Hep B Peds NOS
Latest Date to Give  5/29/15
Overdue Date  5/29/15
Dose #  2
Dose in Series  3
Link to full record  Vendor Supplied
   
Patient Name  Juana Maria Gonzales Morales
Preferred Contact Method  Phone
Contact information using preferred contact (email, text, phone, mailing address)   (203) 555-1214
Patient Identifier Number   Vendor Supplied
Patient Identifier Type Code   Vendor Supplied
Date/Time of Birth   3/30/2015 11:15am
Sex   Female
Vaccine Group   Hep B Peds NOS
Latest Date to Give  5/29/15
Overdue Date   5/29/15
Dose #     2
Dose in Series    3
Link to full record   Vendor Supplied

Notes to Testers

No Note